title: Single or tandem autologous stem-cell transplantation for first-relapsed or refractory Hodgkin lymphoma: 10-year follow-up of the prospective H96 trial by the LYSA/SFGM-TC study group.
abstract: We assessed the long-term results of autologous stem-cell transplantation for patients with first-relapsed or refractory Hodgkin lymphoma included in the prospective Lymphoma Study Association/Société Française de Greffe de Moelle H96 trial. This large multicenter phase II trial evaluated a risk-adapted strategy with single or tandem autologous stem-cell transplantation for 245 Hodgkin lymphoma patients. Poor-risk patients (n=150) had primary refractory Hodgkin lymphoma (n=77) or ≥2 risk factors at first relapse (n=73) and were eligible for tandem autologous stem-cell transplantation. Intermediate-risk patients (n=95) had one risk factor at first relapse and were eligible for single autologous stem-cell transplantation. With a median follow-up of 10.3 years, 10-year freedom from second failure and overall survival rates were, respectively: 64% (95% CI, 54% to 74%) and 70% (95% CI, 61% to 80%) for the intermediate-risk group, and 41% (95% CI, 33% to 49%) and 47% (95% CI, 39% to 55%) for the poor-risk group. Considering only patients who did not relapse after completing autologous stem-cell transplantation, the 15-year cumulative incidences of second primary malignancies were 24% for the 70 intermediate-risk patients and 2% for the 75 poor-risk ones. With long-term follow-up, the risk-adapted strategy remains appropriate. Tandem autologous stem-cell transplantation can still be considered an option for poor-risk patients, but integration of positron-emission tomography findings and new drugs may help to refine the need for a second autologous stem-cell transplant and possibly improve outcomes of patients with first-relapsed or refractory Hodgkin lymphoma.
authors.affiliation: Hématologie, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes - Sorbonne Paris Cité, Imagine Institute, France david.sibon@aphp.fr.
authors.forename: David
authors.initials: D
authors.lastname: Sibon
authors.affiliation: Hôpital Claude Huriez, Lille, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Morschhauser
authors.affiliation: Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Sorbonne Paris Cité, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Resche-Rigon
authors.affiliation: Institut Gustave Roussy, Villejuif, France.
authors.forename: David
authors.initials: D
authors.lastname: Ghez
authors.affiliation: Hôpital Henri-Mondor, AP-HP, Université Paris-Est, Créteil, France.
authors.forename: Jehan
authors.initials: J
authors.lastname: Dupuis
authors.affiliation: Hématologie, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes - Sorbonne Paris Cité, Imagine Institute, France.
authors.forename: Ambroise
authors.initials: A
authors.lastname: Marçais
authors.affiliation: Hôpital Cochin, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Deau-Fischer
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: Reda
authors.initials: R
authors.lastname: Bouabdallah
authors.affiliation: Centre Léon Bérard, Lyon; and Université Claude-Bernard Lyon 1, Pierre-Bénite, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sebban
authors.affiliation: Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Pierre-Bénite, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Salles
authors.affiliation: Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Sorbonne Paris Cité, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Brice
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D019008:Drug Resistance, Neoplasm; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006689:Hodgkin Disease / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome