Long-Term Results of Blood and Marrow Transplantation for Hodgkin’s Lymphoma

Akpek, Görgün; Ambinder, Richard F.; Piantadosi, Steven; Abrams, Ross A.; Brodsky, Robert A.; Vogelsang, Georgia B.; Zahurak, Marianna; Fuller, Donald J.; Miller, Carole B.; Noga, Stephen J.; Fuchs, Ephraim J.; Flinn, Ian W.; O’Donnell, Paul V.; Seifter, Eli; Mann, Risa B.; Jones, Richard J.

doi:10.1200/jco.2001.19.23.4314

Cited by 156 publications

(117 citation statements)

References 23 publications

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“…It was demonstrated that the disadvantage of male sex, which was a known adverse prognostic factor in HL at diagnosis [19], persisted even after the performance of allogeneic HSCT. Some studies have suggested the existence of a graft-versusHodgkin lymphoma effect [18,20,21]. In our study, the presence of acute or chronic GVHD did not affect PFS and RR.…”

Section: Discussionsupporting

confidence: 45%

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The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

et al. 2014

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on behalf of the Adult Lymphoma Working Group of the Japanese Society for Hematopoietic Cell TransplantationThe optimal treatment strategy with the use of hematopoietic stem cell transplantation (HSCT) for relapsed and refractory Hodgkin lymphoma (HL) remains unclear. We performed a retrospective analysis using registry data from the Japanese Society for Hematopoietic Cell Transplantation. Adult patients with HL who underwent a first autologous or a first allogeneic HSCT between 2002 and 2009 were included. Patients who underwent HSCT in first complete remission (CR) were excluded. Autologous and allogeneic HSCT were performed in 298 and 122 patients, respectively. For autologous HSCT, overall survival at 3 years (3yOS) was 70%, and sex, age, disease status, and performance status (PS) at HSCT were prognostic factors. OS was favorable even in patients who underwent autologous HSCT in disease status other than CR. For allogeneic HSCT, 3yOS was 43%, and sex and PS at HSCT were prognostic factors. Disease status at HSCT, previous autologous HSCT, and conditioning intensity did not affect OS. Moreover, graft-versus-host disease did not affect progression-free survival or relapse/progression rate. A first allogeneic HSCT without a previous autologous HSCT was performed in 40 patients. 3yOS was 45%, and was significantly inferior to that in patients who underwent their first autologous HSCT. This result was retained after the correction by the different patient characteristics according to the type of HSCT. In conclusion, autologous HSCT is effective in prolonging survival in patients with relapsed and refractory HL. Allogeneic HSCT might be beneficial even to relapsed HL after autologous HSCT, although establishing the role of allogeneic HSCT remains a challenge.

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Section: Discussionsupporting

confidence: 45%

“…Akpek et al compared autologous HSCT and allogeneic HSCT from an HLA-matched sibling for patients with relapsed and refractory HL who had not received HSCT previously [20]. They demonstrated that there were no significant differences in OS and RR.…”

Section: Discussionmentioning

confidence: 99%

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

et al. 2014

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“…Transplant results have improved over time, probably due to improvements in supportive care and refinements in patient selection. 10,16,27 Thus, the lack of difference further supports the conclusion that eBEAM does not seem to improve results. We did find better EFS and OS with eBEAM over sBEAM in HD patients, although the difference did not reach statistical significance.…”

Section: Discussionsupporting

confidence: 68%

Results of autologous transplantation in lymphoma are not improved by increasing the dose of etoposide in the BEAM regimen: a single-centre sequential-cohort study

Martı́n

Caballero

Pérez‐Simón

et al. 2004

Bone Marrow Transplant

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Summary:We have undertaken a retrospective sequential-cohort analysis of 131 lymphoma patients treated with the BEAM regimen and autologous stem cell transplantation, to compare BEAM at standard doses (sBEAM; n ¼ 67 from May 1990 to April 1995) and BEAM with escalated etoposide dose from 800 to 1600 mg/m 2 (eBEAM; n ¼ 64 from May 1995 to June 1999). Transplant-related mortality and incidence of secondary malignancies were similar in both groups. Disease progression was significantly lower in indolent lymphoma (IL) patients receiving eBEAM (7 vs 43%), although survival was comparable due to a higher toxic mortality in the eBEAM group. The 5-year event-free survival and overall survival were better in Hodgkin's disease (HD) patients treated with eBEAM (70 and 77%, respectively) compared to sBEAM (58 and 69%, respectively), but the difference was not statistically significant. In aggressive lymphomas, no difference was detected between groups. Our results indicate that while escalation of the etoposide doses in the BEAM conditioning regimen does not appear to improve outcome, encouraging results in IL and HD may warrant further studies. High-dose chemotherapy supported by autologous stemcell transplantation (ASCT) is widely used for relapsing or resistant non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) patients, and may be a promising procedure for initial therapy of aggressive NHL with poor prognostic features. 1 Under 35% of HD and under 20% of aggressive NHL patients achieve long-term disease-free survival (DFS) with conventional chemotherapy. 2-4 ASCT results in DFS of 30-65% in primary refractory or relapsed HD 5-10 and 30-50% in aggressive NHL. [11][12][13][14][15][16] Randomized studies have demonstrated the superiority of ASCT to standard salvage chemotherapy for patients with resistant or relapsed HD, 2,3 relapsed aggressive lymphoma 4 or relapsed follicular lymphoma. 17 These results suggest a correlation between dose intensity and disease control. Thus, it is possible that further doseintensification of the conditioning regimen may improve outcome of patients undergoing ASCT. Escalation of the BCNU dose in BEAM and CBV regimens has resulted in increased mortality due to interstitial pneumonitis. 18,19 Escalation of the melphalan dose resulted in increased mucositis and haemorrhagic cystitis. 20 Mills et al 21 escalated the dose of etoposide in the BEAM protocol from 800 to 1600 mg/m 2 over 4 days, and then to 2400 mg/m 2 over 4 days. The maximum tolerable dose was 1600 mg/m 2 over 4 days, but no conclusions could be drawn regarding the impact of the escalated etoposide dose on tumour response and DFS. We have confirmed 22 that increasing the etoposide dose from 800 to 1600 mg/m 2 in BEAM regimen is not associated with greater early toxicity.We have now analysed the impact of the etoposide dose in 131 lymphoma patients in terms of early and late toxicities, response and survival. Patients and methods PatientsA total of 131 consecutive lymphoma patients treated at a single institution with the BEAM ...

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“…64 While MDS/sAML is a significant concern in heavily pretreated high-risk relapsed/ refractory lymphoma patients treated with high-dose therapy and AutoSCT, MDS/sAML is a rare complication after AlloSCT. 65 …”

Section: Sct For Childhood Hdmentioning

confidence: 99%

Stem cell transplantation for pediatric lymphoma: past, present and future

Bradley

Cairo

2007

Bone Marrow Transplant

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Lymphoma is the third most common cancer in children p15 years of age. The prognosis for children with newly diagnosed chemosensitive non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) has improved significantly. However, in children with relapsed and refractory NHL, the prognosis is not as promising and the best treatment approach for this poor risk group continues to be a challenge. Between 25 and 30% of patients with advanced stage HD still relapse and in subsets of this group, the outcome is dismal. Aggressive chemotherapy followed by autologous bone marrow transplantation has been used with some improvement in survival. Some centers have investigated allogeneic stem cell transplantation in pediatric patients with recurrent/relapsed lymphoma. There is little consistency in therapeutic approaches and there is no formal recommendation on the best approach for this poor prognostic subgroup. We illustrate the reported pediatric experience of transplantation for lymphoma and discuss how the results from these trials are influencing how we approach the treatment in certain subgroups of pediatric patients with relapsed/ refractory lymphoma.

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Long-Term Results of Blood and Marrow Transplantation for Hodgkin’s Lymphoma

Abstract: There seems to be a clinical graft-versus-HL effect associated with allo BMT. Allo BMT for HL also seems to have a lower risk of secondary AML/MDS than auto BMT. Thus, allo BMT warrants continued study in HL.

Cited by 156 publications

References 23 publications

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

Results of autologous transplantation in lymphoma are not improved by increasing the dose of etoposide in the BEAM regimen: a single-centre sequential-cohort study

Stem cell transplantation for pediatric lymphoma: past, present and future

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