High dose chemotherapy followed by autologous stem cell transplantation for relapsed or refractory Hodgkin’s lymphoma

Abstract

7552 Background: High dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) can produce long-term durable remissions in patients (PTS) with relapsed or refractory Hodgkin’s lymphoma (HL). We investigated whether previously reported prognostic factors could predict overall survival (OS) and progression free survival (PFS) in a modern cohort of PTS, and attempted to identify any subgroup with a particularly inferior survival. Methods: A retrospective chart review was performed on all PTS with relapsed or refractory HL who received HDT and ASCT at a single institution. Results: From 1990 to 2001, 115 PTS received HDT followed by ASCT for relapsed or refractory HL. 76/109 PTS (70%) had achieved a complete response to initial therapy. Median time from initial therapy to relapse (TTR) was 18 months (range, 0–220 months). 105 PTS (91%) received HDT with cyclophosphamide, BCNU, and VP-16. The source of stem cells was bone marrow in 68 PTS (59%) and peripheral blood in 47 PTS (41%). Five year PFS and OS were 46% and 58%, respectively, with a median follow-up of 58 months (range, 1–175 months). The five year PFS and OS of the 13 PTS (11%) with primary refractory disease was 39% and 54%, respectively, not significantly different. 59 PTS (51%) died after HDT and ASCT. The most common cause of death was relapsed HL. Regimen related mortality accounted for 8 deaths (7%). Male gender and TTR <12 months were associated with decreased OS by univariate analysis (P = 0.04 and P = 0.03, respectively). Similar, but non-significant trends were noted in PFS. In multivariate analysis, only TTR <12 months was associated with a statistically significant decrease in OS (P = 0.04). Five year OS for patients with TTR <12 and ≥12 months was 44% and 63%, respectively. Second malignancies occurred in 9 PTS (8%). The most common diagnosis was myelodysplastic syndrome/acute myelogenous leukemia [n = 6 (67%)]. Conclusions: We have confirmed that HDT and ASCT produces long-term PFS and OS in a proportion of PTS with relapsed or refractory HL. TTR <12 months was associated with a statistically significant decrease in OS by multivariate analysis; however, no group of PTS, including those with primary refractory disease, could be identified who did not benefit from HDT and ASCT. No significant financial relationships to disclose.