High-Dose Therapy and Autologous Stem Cell Transplantation for Chemoresistant Hodgkin Lymphoma : The Seattle Experience

• Published in: Cancer Vol. 113; no. 6; pp. 1344 - 1350
• Main Authors: GOPAL, Ajay K, METCALFE, Tracee L, GOOLEY, Ted A, PAGEL, John M, PETERSDORF, Stephen H, BENSINGER, William I, HOLMBERG, Leona, MALONEY, David G, PRESS, Oliver W
• Format: Journal Article
• Language: English
• Published: New York, NY Wiley-Liss 15-09-2008
• Subjects: Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biological and medical sciences; Drug Resistance, Neoplasm; Female; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Hodgkin Disease - complications; Hodgkin Disease - drug therapy; Hodgkin Disease - therapy; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Neoplasm Staging; Salvage Therapy; Survival Rate; Transplantation Conditioning; Transplantation, Autologous; Treatment Outcome; Tumors; Stem cell; progression-free survival; autologous stem cell transplantation; Hematopoietic cell; Hodgkin disease; Malignant hemopathy; Lymphoma; high-dose therapy; Autograft; Cancerology; Treatment; Lymphoproliferative syndrome; Progression free survival; Graft; chemoresistant; High dose; Cancer; Hodgkin lymphoma
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.23715

High-dose therapy (HDT) with autologous stem cell transplantation (ASCT) is the standard treatment for patients with chemosensitive relapsed/refractory Hodgkin lymphoma (HL), but this therapy is commonly denied to patients with resistant disease. We explored the utility of HDT and ASCT for chemoresistant HL because there are few established therapies for these patients.
Sixty-four chemoresistant HL patients underwent HDT followed by ASCT at our center. Baseline characteristics included median age = 35 years (range, 14-59 years), stage III/IV = 49 (77%), nodular sclerosis histology = 51 (80%), and prior radiation = 32 (50%). Twenty-six patients (41%) received total body irradiation (TBI)-based regimens, and 38 (59%) underwent non-TBI conditioning.
The estimated 5-year overall survival (OS) and progression-free survival (PFS) were 31% and 17%, respectively (median follow-up = 4.2 years). Multivariate analysis only identified year of transplant as independently associated with improved OS (P = .008) and PFS (P = .04), with patients receiving transplants in later years having better outcome. The probabilities of 3-year PFS for patients receiving transplants during 1986 to 1989, 1990 to July 1993, August 1993 to 1999, and 2000 to 2005 were 9%, 21%, 33%, and 31%, respectively.
These data suggest that HDT and ASCT may result in prolonged remissions and survival for a subset of chemoresistant HL patients, with improved outcomes in patients receiving transplants more recently.