High-dose chemotherapy and autologous bone marrow transplant in relapsed Hodgkin's disease - a pragmatic prognostic index

Abstract

Summary High-dose chemotherapy with autologous bone marrow transplantation is used in the treatment of relapsed or high-risk Hodgkin's disease. As From the observation that patients with relapsed disease when treated with conventional chemotherapy have a progression-free survival (PFS) of around 30% and a median survival of 12 months, it has become accepted that fit patients with HD who have a first remission of < 12 months' duration, those who fail to achieve a complete remission (CR) with satisfactory induction therapy including an anthracycline, or those patients who are in second or subsequent relapse, or high-risk patients in first relapse, should be treated in this way Longo et al., 1992 . The trial demonstrates the difficulty in recruiting to a trial in which one of the treatment modalities, although unproven, is seen to be the best chance of long-term survival. A few years into this randomised study, patients were refusing to be randomised and requested high-dose treatment.We report our experience at a single centre treating relapsed or non-responding HD, the most common category of patients seen being the sensitive relapses with a varying number in each other subgroup. With long follow-up we report both long-and short-term toxicity, response rates and prognostic factors to help predict which patients will have a long PFS Patients and methods

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

“…We also corroborated the observations of several noting that resistant relapse heralded an inferior result after transplant. 38,42,47 It is unclear why MOPP therapy at diagnosis provided inferior outcome, and no single cause of death accounted for this finding.…”

“…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.…”

Prognostic factors for disease progression after high-dose chemotherapy and autologous hematopoietic stem cell transplantation for recurrent or refractory Hodgkin's lymphoma

“…Various factors have been reported to influence the outcome after HDT and autologous transplantation for HL. These include performance status, 21,23,31 number of prior chemotherapy regimens, [21][22][23][24]27,30,33 the presence of bulky disease, 27,34 the length of initial remission, 29 the presence of extranodal disease, [29][30][31] clinical stage, 28 the presence of B symptoms at the time of transplantation, 22,28,29 and sensitivity to conventional chemotherapy. 22,33,35,36 However, many of these factors are highly correlated and the independent effects of each may be difficult to evaluate.…”

“…This strategy produces durable remissions in many of these patients. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Late relapses, secondary myelodysplasia/ leukemia, and secondary solid tumors may occur, which effects their long-term survival. Selected patients who suffer a relapse after the first transplantation may be salvaged with a second autologous or allogeneic transplantation.…”

Idiopathic pneumonia syndrome after high-dose chemotherapy for relapsed Hodgkin's disease

“…The indications for HDC and assessment criteria are as described previously (O'Brien et al, 1996). Toxicity was graded according to the common toxicity criteria (National Cancer Institute, 1988 …”