Prognostic factors for survival after high-dose therapy and autologous stem cell transplantation for patients with relapsing Hodgkin’s disease: analysis of 280 patients from the French registry

Abstract

Summary:second line regimen (1 factor) and more intensive treatments for the bad prognosis group (2 factors). High-dose therapy with autologous stem cell transplanKeywords: Hodgkin's disease; relapse; high-dose tation (ASCT) has been widely proposed for patients therapy; autologous bone marrow transplantation with relapsed Hodgkin's disease (HD). From 1982 to 1993, we selected (from the French registry for bone marrow transplantation) 280 patients, who underwent ASCT for relapsed HD after initial treatment includingThe majority of patients with Hodgkin's disease (HD) can chemotherapy. Patient characteristics at diagnosis were:be cured by conventional doses of chemotherapy and/or sex ratio (M/F): 1.5; median age: 30 years (5-59 years), radiotherapy. 1,2 According to known prognostic factors at stage I, II: 43%; III, IV: 57%; 32% had chemotherapy, diagnosis (age, erythrocyte sedimentation rate, B-symp-68% chemo؉ radiotherapy. All patients achieved comtoms, mediastinal mass, extranodal involvement, hemogloplete remission after first-line therapy and subsequently bin, lactate dehydrogenase (LDH)), 3,4 10-40% of patients relapsed. The median interval between diagnosis and with HD who achieve complete remission (CR) after initial high-dose therapy was 34 months. First relapse treatment will relapse. 5,6 Long-term outcome after a first occurred in 78% of the patients at a median end-ofrelapse remains poor with survival below 50%, especially treatment to relapse time of 18 months. All patients in patients with a time from primary treatment to failure received salvage chemotherapy before high-dose therless than 1 year. 7 The role of high-dose therapy with autoapy, and the median time between relapse and highlogous hematopoietic stem cell transplantation (ASCT) has dose therapy was 5 months. After this regimen, 84%been widely investigated in patients with refractory or of the patients were considered to have chemosensitive relapsing HD. [8][9][10][11] High-dose therapy in this setting is assorelapse. Conditioning regimens were: BEAM: 60%; ciated with higher CR rates and progression-free survivals CBV/BEAC: 26%. Transplant-related mortality was ranging from 30 to 50%. A randomized study by the British 6%. With a median follow-up of 3 years after high-dose National Lymphoma Investigation group has demonstrated therapy, overall and progression-free survivals at 4 a clear advantage in terms of event-free survival in favor years were, 66 and 60%, respectively. Neither the conof high-dose therapy compared to conventional-dose treatditioning regimen nor the stem cell source affected surment. 12 vival. Good prognostic factors for survival were: chemoDespite all these studies, it remains difficult to know sensitivity of relapse (P Ͻ 0.001) and first relapse vs whether all patients with relapsing HD will benefit signififurther relapse (P Ͻ 0.05). For 214 patients in first cantly from such intensive approaches and most reports in relapse, other significant factors for survival were: endthis context have included heterogeneous grou...

Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma

“…Of particular importance, these responses are seen in a heavily pretreated population with several poor prognostic features such as chemo-resistant disease (Josting et al, 2000), relapse within a year (Brice et al, 1997;Guglielmi et al, 1998), advanced disease stage (Blay et al, 1998) and previous ASCT. Response to salvage chemotherapy is important prior to ASCT, as it is correlated with survival post-transplant (Philip et al, 1987;Brice et al, 1997). Another significant finding was that treatment with GEM-P did not appear to inhibit stem cell harvesting, although this was not an end point of the study.…”

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

“…Reported diseasefree and overall survival rates are as high as 61-79%. [32][33][34][35][36][37][38][39] Although all of the series in Table 7 examined the outcome of autotransplantation in first relapse, eligibility criteria differed. For example, the studies by Yahalom et al, 32 Chopra et al, 33 and Nademanee et al 35 included only patients relapsing within 1 year of completing therapy and/or failing to respond to salvage chemotherapy.…”

Tandem transplant of peripheral blood stem cells for patients with poor-prognosis Hodgkins’s disease or non-Hodgkin’s lymphoma

“…Thus, for the relapse group, inclusion criteria were: refractory disease or end-of-treatment to relapse interval Ͻ1 year. 13,14,31 In addition, nine patients with aggressive lymphoma with at least two adverse prognostic factors according to the IPI, received this tandem protocol as first-line therapy after debulking chemotherapy with ACVBP induction. 7 In this group of patients, the remission rate is only 65% and tandem high-dose procedures may have a role in treatment strategies to improve the response rate and consolidation.…”

“…The initial chemosensitivity to salvage chemotherapy remained the most important prognostic factor. [10][11][12] The proportion of patients salvaged by HDT ϩ ASCT reached 45-60% in patients with good prognostic features according to the prognostic model proposed by Vose et al 13 for NHL patients and by Brice et al 14 for those with HD. However, for patients with adverse prognostic factors, the probability of being cured decreases rapidly to under 40% with standard conditioning regimen and ASCT.…”