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Long-term results of autologous stem cell transplantation for primary refractory or relapsed Hodgkin's lymphoma.
Biol Blood Marrow Transplant. 2006 Oct; 12(10):1065-72.BB

Abstract

Autologous hematopoietic stem cell transplantation (ASCT) has become standard therapy for primary refractory (PR REF) or relapsed (REL) Hodgkin's lymphoma (HL); however, more than half of these patients eventually relapse and die of their disease. We studied long-term outcomes and evaluated factors influencing progression-free survival (PFS) in 141 patients with PR REF or REL HL who underwent ASCT between 1985 and 2003. Median age at ASCT was 30 years (range, 7-60 years); 21 patients had PR REF, and 120 had REL HL. With a median follow-up of 6.3 years (range, 1-20 years), the probability of PFS at 5 and 10 years was 48% (95% confidence interval [CI], 39%-57%) and 45% (95% CI, 36%-54%) and that of overall survival (OS) was 53% (95% CI, 44%-62%) and 47% (95% CI, 37%-57%), respectively. Transplant-related mortality at 100 days was 1.4%. Among 45 5- to 20-year survivors, no late relapses of HL were observed. In multivariate analysis, 3 factors were independently predictive of poor PFS: chemoresistant disease (relative risk [RR], 2.9; 95% CI, 1.7-5.0), B-symptoms at pretransplantation relapse (RR, 2.1; 95% CI, 1.3-3.4), and presence of residual disease at the time of transplantation (RR, 2.3; 95% CI, 1.1-4.8). Patients with 0 or 1 of these 3 adverse factors (low-risk disease) had a 5-year PFS of 67% (95% CI, 55%-79%) compared with 37% (95% CI, 22%-52%) in those with 2 factors (intermediate-risk group) and 9% (95% CI, 0-20%) in those with all 3 factors (high-risk group) (P < .001). The rates of OS at 5 years were 71% (95% CI, 60%-82%), 49% (95% CI, 33%-65%) and 13% (95% CI, 0-27%) in the 3 groups, respectively (P < .001). ASCT is associated with durable PFS in appropriately selected patients with PR REF or REL HL. Using a simple prognostic model, we can identify patients with high-risk disease who have predictably unfavorable outcome after ASCT and require novel therapeutic approaches. A risk-adapted approach should be followed in determining treatment options for patients with PR REF and REL HL.

Authors+Show Affiliations

Blood and Marrow Transplant Program, Divisions of Medical and Pediatric Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

17084370

Citation

Majhail, Navneet S., et al. "Long-term Results of Autologous Stem Cell Transplantation for Primary Refractory or Relapsed Hodgkin's Lymphoma." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 12, no. 10, 2006, pp. 1065-72.
Majhail NS, Weisdorf DJ, Defor TE, et al. Long-term results of autologous stem cell transplantation for primary refractory or relapsed Hodgkin's lymphoma. Biol Blood Marrow Transplant. 2006;12(10):1065-72.
Majhail, N. S., Weisdorf, D. J., Defor, T. E., Miller, J. S., McGlave, P. B., Slungaard, A., Arora, M., Ramsay, N. K., Orchard, P. J., MacMillan, M. L., & Burns, L. J. (2006). Long-term results of autologous stem cell transplantation for primary refractory or relapsed Hodgkin's lymphoma. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 12(10), 1065-72.
Majhail NS, et al. Long-term Results of Autologous Stem Cell Transplantation for Primary Refractory or Relapsed Hodgkin's Lymphoma. Biol Blood Marrow Transplant. 2006;12(10):1065-72. PubMed PMID: 17084370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term results of autologous stem cell transplantation for primary refractory or relapsed Hodgkin's lymphoma. AU - Majhail,Navneet S, AU - Weisdorf,Daniel J, AU - Defor,Todd E, AU - Miller,Jeffrey S, AU - McGlave,Philip B, AU - Slungaard,Arne, AU - Arora,Mukta, AU - Ramsay,Norma K C, AU - Orchard,Paul J, AU - MacMillan,Margaret L, AU - Burns,Linda J, PY - 2006/01/31/received PY - 2006/06/06/accepted PY - 2006/11/7/pubmed PY - 2007/3/21/medline PY - 2006/11/7/entrez SP - 1065 EP - 72 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 12 IS - 10 N2 - Autologous hematopoietic stem cell transplantation (ASCT) has become standard therapy for primary refractory (PR REF) or relapsed (REL) Hodgkin's lymphoma (HL); however, more than half of these patients eventually relapse and die of their disease. We studied long-term outcomes and evaluated factors influencing progression-free survival (PFS) in 141 patients with PR REF or REL HL who underwent ASCT between 1985 and 2003. Median age at ASCT was 30 years (range, 7-60 years); 21 patients had PR REF, and 120 had REL HL. With a median follow-up of 6.3 years (range, 1-20 years), the probability of PFS at 5 and 10 years was 48% (95% confidence interval [CI], 39%-57%) and 45% (95% CI, 36%-54%) and that of overall survival (OS) was 53% (95% CI, 44%-62%) and 47% (95% CI, 37%-57%), respectively. Transplant-related mortality at 100 days was 1.4%. Among 45 5- to 20-year survivors, no late relapses of HL were observed. In multivariate analysis, 3 factors were independently predictive of poor PFS: chemoresistant disease (relative risk [RR], 2.9; 95% CI, 1.7-5.0), B-symptoms at pretransplantation relapse (RR, 2.1; 95% CI, 1.3-3.4), and presence of residual disease at the time of transplantation (RR, 2.3; 95% CI, 1.1-4.8). Patients with 0 or 1 of these 3 adverse factors (low-risk disease) had a 5-year PFS of 67% (95% CI, 55%-79%) compared with 37% (95% CI, 22%-52%) in those with 2 factors (intermediate-risk group) and 9% (95% CI, 0-20%) in those with all 3 factors (high-risk group) (P < .001). The rates of OS at 5 years were 71% (95% CI, 60%-82%), 49% (95% CI, 33%-65%) and 13% (95% CI, 0-27%) in the 3 groups, respectively (P < .001). ASCT is associated with durable PFS in appropriately selected patients with PR REF or REL HL. Using a simple prognostic model, we can identify patients with high-risk disease who have predictably unfavorable outcome after ASCT and require novel therapeutic approaches. A risk-adapted approach should be followed in determining treatment options for patients with PR REF and REL HL. SN - 1083-8791 UR - https://www.unboundmedicine.com/medline/citation/17084370/Long_term_results_of_autologous_stem_cell_transplantation_for_primary_refractory_or_relapsed_Hodgkin's_lymphoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(06)00420-4 DB - PRIME DP - Unbound Medicine ER -