title: Autologous stem cell transplantation for refractory or poor-risk relapsed Hodgkin's lymphoma: effect of the specific high-dose chemotherapy regimen on outcome.
abstract: More active high-dose chemotherapy (HDC) regimens are needed for refractory Hodgkin's lymphoma (HL). We report a cohort analysis of 180 consecutive patients with primary refractory or poor-risk relapsed HL treated with busulfan-melphalan (Bu-Mel) (n = 39), gemcitabine-busulfan-melphalan (Gem-Bu-Mel) (n = 84), or BEAM (BCNU, etoposide, ara-C, melphalan; n = 57) between 2005 and 2010. Their pre-HDC positron emission tomography (PET) scans were interpreted prospectively. Despite more prevalent poor-risk features in the Gem-Bu-Mel cohort, such as PET-positive tumors at HDC, tumors growing at HDC, extranodal disease, or bulky tumors at prior relapse, this cohort had improved outcomes compared with the Bu-Mel and BEAM cohorts, with event-free survival (EFS) rates of 57%, 33%, and 39%, respectively (P = .01), at median follow-up of the whole population of 36 months (range, 3 to 72). Their respective overall survival (OS) rates were, respectively, 82%, 52%, and 59% (P = .04). Secondary acute myelogenous leukemia was seen in 5 patients after BEAM but was not seen in Gem-Bu-Mel and Bu-Mel cohorts (P = .004). Multivariate analyses showed independent adverse effects of an HDC regimen different from Gem-Bu-Mel (hazard ratio [HR] for EFS = 2.3, P = .0008; HR for OS = 2.7, P = .0005), positive PET at HDC (HR for EFS = 2.2, P = .004, HR for OS = 3.1, P = .0001), and >1 previous salvage line (HR for EFS = 1.9, P = .008, HR for OS = 1.8, P = .07). Gem-Bu-Mel improved outcomes in this cohort analysis of patients with refractory/poor-risk relapsed HL and merits evaluation in randomized phase III trials.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. ynieto@mdanderson.org
authors.forename: Yago
authors.initials: Y
authors.lastname: Nieto
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Ben
authors.initials: B
authors.lastname: Valdez
authors.forename: Borje
authors.initials: B
authors.lastname: Andersson
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
authors.forename: Amin
authors.initials: A
authors.lastname: Alousi
authors.forename: Partow
authors.initials: P
authors.lastname: Kebriaei
authors.forename: Muzaffar
authors.initials: M
authors.lastname: Qazilbash
authors.forename: Simrit
authors.initials: S
authors.lastname: Parmar
authors.forename: Qaiser
authors.initials: Q
authors.lastname: Bashir
authors.forename: Nina
authors.initials: N
authors.lastname: Shah
authors.forename: Issa
authors.initials: I
authors.lastname: Khouri
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.forename: Roy B
authors.initials: RB
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D002066:Busulfan / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D011877:Radionuclide Imaging; D012008:Recurrence; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002066:Busulfan; D008558:Melphalan; D000093542:Gemcitabine