engleski

AUTOLOGOUS STEM CELL TRANSPLANTATION (ASCT) FOR RELAPSED OR REFRACTORY HODGKIN’S LYMPHOMA (HL): A SINGLE-CENTER EXPERIENCE

Background. Relapsing patients with HL are usually treated with intensive chemotherapy and ASCT since mid 1990s. Pretransplant cytoreductive chemotherapy regimens and supportive care changed during this period but it is not known whether this affects outcome. Aims. Analyze outcome of relapsing / refractory HL patients treated with ASCT in a single center between 1994 and 2010. Identify variables affecting outcome. Methods. Retrospective study performed by chart review. All patients received supportive care standard at the time of transplantation ; pretransplant cytoreductive therapy varied, but all were conditioned using BEAM or BEAC. Areas not in CR prior to transplantation were irradiated after hematological recovery. Results. During this period 87 patients, 52 men and 35 women, 15-55 years old (median 30) with relapsed / refractory HL were autografted at our institution. Thirty-one were refractory, 26 in early relapse, 25 in late relapse and 5 had multiple relapses prior to transplantation. Sixty patients had nodular sclerosis, 22 mixed cellularity, 2 lymphocyte predominant HL and in 3 the type was unknown. With a median followup of 34 months 3-year and 5- year overall survival (OS) of the entire cohort are 78% and 66% and event-free survival (EFS) 66% and 60% respectively (Fig). HL type, response to last previous treatment (refractory vs. early relapse vs. late relapse vs. multiple relapses), pretransplant therapy (miniBEAM vs. DHAP vs. high-dose ifosfamide and mitoxantrone) and date of transplantation did not affect outcome. Older age at transplantation was a negative prognostic factor for OS but not EFS. The only statistically significant prognostic factor that we were able to identify was response to pretransplant cytoreductive therapy. In the group transplanted in CR, 3-year OS was 87% and EFS 85%, in PR 80% and 63%, in stable disease 52% and 20% and in progressive disease 25% and 25% respectively. This difference is highly statistically significant (p<0, 001, log-rank test). Conclusions.Outcome of autografted HL patients has not changed significantly in the last 15 years. Sixty percent of these patients remain long-term free of their cancer. In our experience, response to pretransplant cytoreductive chemotherapy is a more important prognostic factor than response to last previous treatment

autologous stem cells; refractory Hodgkins lymphoma

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