Autologous stem cell transplantation for poor prognosis Hodgkin’s disease in first complete remission: a retrospective study from the Spanish GEL-TAMO cooperative group

Abstract

Although more than 50% of Hodgkin's disease patients are cured with conventional chemotherapy, many will relapse and eventually die from their disease. Many efforts have been made to identify poor prognostic factors that could be useful in selecting high-risk patients in 1st CR who may benefit from high-dose chemo/radiotherapy. However, the role of early transplantation in 1st CR remains unclear. We have retrospectively analyzed the results obtained with this procedure in 22 hospitals belonging to the Spanish GEL/TAMO cooperative group. Twenty-seven patients, of whom 19 were males, underwent autologous transplantation for Hodgkin's disease in 1st CR between January 1987 and January 1996. Remission had been achieved after one (n = 22) or two (n = 5) lines of treatment. Twenty-four patients had advanced stage disease, 12 patients bulky mediastinal disease, nine bone marrow involvement and 18 had extranodal disease. Peripheral blood was used as the source of hematopoietic stem cells in 15 patients, BM in nine, and both in three. All but three patients received chemotherapy-based conditioning regimens (16 CBV, four BEAM and four BEAC), while three were conditioned with CY and TBI. There were no transplant-related deaths. Median (range) times to recover >0.5 x 10(9)/l neutrophils and >50 x 10(9)/l platelets were 14 (8-56) days and 16 (8-240) days, respectively. With a median follow-up of 30 (8-66) months, 21 patients are alive and in continuous CR. Four patients who relapsed after transplant at 8, 17.5, 22 and 26 months achieved a second CR with conventional chemotherapy; one patient relapsed 92 months post-transplant and died 5 months afterwards. Another patient died 30.5 months post-transplant from a secondary malignancy. In conclusion, high-dose therapy in poor prognosis Hodgkin's disease in 1st CR was well tolerated with no transplant-related mortalities. Although the follow-up of this series is relatively short, our results seem promising. Nevertheless, late relapses can occur, and the role of this procedure vs conventional treatment in very high-risk patients should be assessed in prospective randomized studies.

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

“…On the other hand, there is a trend today to introduce megatherapy with ASCT as first-line treatment in adults with poor prognosis HD. [7][8][9][10] A high percentage of children can be cured after conventional treatment, even those with advanced disease at diagnosis, 11,12 so that, ASCT is not being used as part of front-line therapy in childhood. Nevertheless, the prognosis of children who fail to attain complete remission or who relapse after conventional treatment is poor, particularly if relapse occurs after a short complete remission.…”

High-Dose Therapy in Lymphomas: A Review of the Current Status of Allogeneic and Autologous Stem Cell Transplantation in Hodgkin's Disease and Non-Hodgkin's Lymphoma

“…In the nonrandomized control group, with a median follow-up of 89 months, 33% were free of disease. Results of other studies looking at this question are presented in Table 3 [32,[39][40][41]. Because of the significant cure rate with standard-dose therapy in even high-risk patients, this approach is controversial.…”

Early intensive therapy with autologous stem cell transplantation in advanced Hodgkin’s disease: retrospective analysis of 158 cases from the French registry

“…Despite few pilot studies including small numbers of patients, [11][12][13][14] early intensive therapy followed by ASCT in advanced HD remains to be evaluated. This series of 158 patients shows the feasibility of such a strategy.…”

“…10 We and others have given intensive therapy followed by ASCT earlier in the course of the disease as part of frontline treatment in young patients at high risk of failure. These few pilot studies including small numbers of selected patients have described high response rates, [11][12][13][14] but the clinical benefit of early ASCT is still controversial. Longterm follow-up in large series of patients is requisite to address the important issues of efficacy and toxicity, ie peri-ASCT toxic death rate and other potential late-occurring complications related to immunosuppression and treatment-induced oncogenesis, of such a procedure.…”