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High-dose therapy and autologous stem cell transplantation for chemoresistant Hodgkin lymphoma: the Seattle experience.

Gopal, Ajay K and Metcalfe, Tracee L and Gooley, Ted A and Pagel, John M and Petersdorf, Stephen H and Bensinger, William I and Holmberg, Leona and Maloney, David G and Press, Oliver W (2008) High-dose therapy and autologous stem cell transplantation for chemoresistant Hodgkin lymphoma: the Seattle experience. Cancer, 113 (6). pp. 1344-1350. ISSN 0008-543X

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Abstract

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.

Item Type: Article
Additional Information: This is a preprint of an article published in Cancer. 2008 Sep 15;113(6):1344-50. This article is available to subscribers only via the URL above.
DOI: 10.1002/cncr.23715
PubMed ID: 18623377
NIHMSID: NIHMS115907
PMCID: PMC2700660
Grant Numbers: P01 CA044991-21, K23 CA085479-06, K08 CA095448-05
Keywords or MeSH Headings: Antineoplastic Combined Chemotherapy Protocols/administration & dosage; Drug Resistance, Neoplasm; Female; Hematopoietic Stem Cell Transplantation; Hodgkin Disease/complications/drug therapy/therapy; Humans; Male; Middle Aged; Neoplasm Staging; Salvage Therapy; Survival Rate; Transplantation Conditioning; Transplantation, Autologous; Treatment Outcome;
Subjects: Diseases > Hematologic and lymphatic diseases > Lymphoma
Therapeutics > Transplantation > Stem Cell transplantation
Therapeutics > Drug Therapy
Depositing User: Library Staff
Date Deposited: 07 May 2009 20:00
Last Modified: 14 Feb 2012 14:42
URI: http://authors.fhcrc.org/id/eprint/282

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