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High‐dose therapy and autologous stem cell transplantation for chemoresistant Hodgkin lymphoma
Author(s) -
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.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23715
Subject(s) - medicine , autologous stem cell transplantation , transplantation , surgery , lymphoma , nodular sclerosis , total body irradiation , refractory (planetary science) , radiation therapy , progression free survival , chemotherapy , oncology , gastroenterology , hodgkin lymphoma , cyclophosphamide , physics , astrobiology
BACKGROUND. 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. METHODS. 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. RESULTS. 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. CONCLUSIONS. 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. Cancer 2008. © 2008 American Cancer Society.