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

Abstract

This retrospective study was undertaken to evaluate cure rates, toxicity and late effects of early intensive therapy followed by autologous stem cell transplantation (ASCT) in patients with advanced Hodgkin's disease (HD). One hundred and fifty-eight cases of ASCT registered in the French database (SFGM) were retrospectively analyzed. Disease status at the time of ASCT was first partial response (PR) in 85, first complete remission (CR1) in 45 or primary refractory in 28 cases. The median time interval between diagnosis and ASCT was 7 months (range 4-13). At the time of analysis in December 1995, 121/158 patients (76.6%) were alive, including 111 (70.2%) in continuous CR with a median follow-up for surviving patients of 46 months (range 8-123). Peri-ASCT toxic death rate was 3%, and the actuarial risk of new malignancies was 4.9% at 5 years. The cumulative probability of 5-year overall survival (OS) was 75.2% for the entire group of patients, 80.6% for the chemosensitive ones, and 33.9% for the primary refractory (chemosensitive vs refractory, P < 0.0001). The cumulative probability of 5-year event-free survival (EFS) was 66.1% for the entire group of patients, 73.7% for the chemosensitive ones, and 26.1% for the primary refractory (chemosensitive vs refractory, P < 0.0001). The only significant prognostic factor for both OS and EFS was disease status at the time of ASCT. Early ASCT in advanced HD is feasible, with a low risk of toxicity and without a higher rate of late effects compared with conventional treatment. Results achieved in chemosensitive patients at the time of transplantation lay the basis of future prospective randomized trials comparing ACST as front-line treatment to conventional treatment in high-risk cases.

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

“…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.…”

Autologous stem cell transplantation for Hodgkin's disease: busulfan, melphalan and thiotepa compared to a radiation-based regimen

“…5,6,8,10,[12][13][14]17,18,20,21,38,[43][44][45][46][47][48][49] In a study of 65 patients with relapsed or refractory HD, Moskowitz found that B symptoms, extranodal disease and less than 1 year remission duration were all adverse prognostic indicators. 50 A French registry study of 280 patients with HD found chemosensitive disease and first relapse to be good prognostic indicators for survival.…”

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.…”