Autologous stem cell transplantation (ASCT) for poor prognostic Hodgkin’s disease (HD): comparative results with two CBV regimens and importance of disease status at transplant

Abstract

Clinical outcome of 47 consecutive patients with advanced HD who underwent ASCT in our Department was analyzed retrospectively. Median age was 28 years (28 males and 19 females). At transplant, 15 (32%) patients were in CR (five in first CR after two chemotherapy regimens and 10 in second CR), eight (17%) in PR (seven without a prior CR), 22 (51%) had relapsing disease (19 with sensitive relapse) and two had primary refractory disease. The CVB regimen with two different schedules was used: 22 (47%) patients received standard CBV (CY 6 g/m2, BCNU 300 mg/m2 and etoposide 600 mg/m2) and 25 (53%) received an increased CBV dose (CY 7.2 g/m2, BCNU 440 mg/m2 and etoposide 2 g/m2). Antitumor response for 28 evaluable patients was similar for both CBV regimens: 87 and 75% (P=0.39). At 7.2 years, actuarial overall survival (OS), progression-free survival (PFS) and event-free survival (EFS) for the whole series were 51.7+/-8%, 34+/-9% and 28+/-8%, with a median follow-up for the surviving patients of 3 years (0.7-7.6). No differences in these survival functions according to the CBV regimen used were observed (P=0.57). A history of a prior CR (P=0.003), duration of first CR >1 year (P=0.04), absence of bulky nodal disease at transplant (P=0.054), absence of extranodal disease at transplant (P=0.01), and a CR status at transplant (P=0.0006) were associated with a better PFS on univariant analysis. On multivariate analysis, only CR status at transplant remained significant (P=0.05). When patients in second CR at transplant and those in first sensitive relapse were analyzed separately, no differences in clinical characteristics or in treatment received pretransplant were observed; however, PFS was significantly different (P=0.01). In conclusion, CR status at transplant is useful in identifying 'good risk' patients and is necessary to obtain the greatest benefit from ASCT independent of the CBV regimen used.

Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR)

“…Some of these subjects may not proceed to transplantation because of intercurrent medical problems associated with multiple attempts to induce remission. This inherent selection bias may explain, in part, the less favorable results in untested relapse patients, reported by groups such as Sweetenham and colleagues 34 and Arranz et al 40 Thus, superior results for second complete remission patients may not be the result of a beneficial effect of re-induction therapy but rather from identification of good prognosis patients.…”

“…Factors predicting poor outcome in prior studies of autotransplants for relapsed or refractory Hodgkin's disease a Interval from end-of-therapy until relapse Ͻ12 months (34,36,39) у1 extra-nodal disease site at relapse (34,35,39,40) Abnormal ECOG performance status (38,43,46,49,51,52) a Resistant relapse (38,42,47) a B symptoms at relapse (39,48,49) Bulk disease at transplant (33,40,41,44,49,53) Female gender (33) Exposure to many chemotherapeutic regimens prior to transplant (33,35,46,47,51,52) Elevated serum LDH at transplant (50) Relapse in previous radiation field (44) Disseminated lung or marrow disease at relapse (49) a Factors reported specifically in first relapse/second complete remission patients. Numbers in parenthesis refer to study cited.…”

Autologous stem cell transplantation for advanced Hodgkin's disease in children

“…6,14,15 In the current series of patients, high-dose therapy with stem cell rescue was useful for patients who did not achieve complete remission after conventional therapy. Both patients transplanted in partial remission and those transplanted in relapse, attained CR.…”

“…We did not find a significant difference in EFS rates according to disease status at the time of ASCT, probably because of the small size of this group, since status at transplantation has been proven to be a significant prognostic factor in larger series of adult patients. 6,14,15,17 No randomized studies comparing the effectiveness of ASCT vs standard chemotherapy in relapsed children with HD have been reported. Despite the fact that the follow-up time in our series of patients is not yet very long, the overall outcome is encouraging with an overall survival of 0.95 and EFS rate of 0.62.…”

High-dose CEB vs BEAM with autologous stem cell transplant in lymphoma

“…Predicted OS at 8 years (median follow-up 28 months) favored the BEAM regimen over the CEB (CBV) regimen (58 vs 40%). Arranz et al, 18 on univariate analysis, found that absence of extranodal disease and CR status at transplant were associated with better PFS. In our study, more patients in the CEB group were in CR at the time of ASCT than in the BEAM group, and more CEB patients had a history of prior CR than BEAM; however, more patients who received CEB had extranodal disease than patients who received BEAM (55 vs 20%, Po0.05).…”