Autotransplants for Hodgkin's disease in first relapse or second remission: A report from the autologous blood and marrow transplant registry (ABMTR)

H. M. Lazarus, F. R. Loberiza, M. J. Zhang, J. O. Armitage, K. K. Ballen, A. Bashey, B. J. Bolwell, L. J. Burns, C. O. Freytes, R. P. Gale, J. Gibson, R. H. Herzig, C. F. LeMaistre, D. Marks, J. Mason, A. M. Miller, G. A. Milone, S. Pavlovsky, D. E. Reece, J. D. RizzoK. Van Besien, J. M. Vose, M. M. Horowitz

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92 Scopus citations

Abstract

Although patients with relapsed Hodgkin's disease have a poor prognosis with conventional therapies, high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autotransplantation) may provide long-term progression-free survival. We reviewed data from the Autologous Blood and Marrow Transplant Registry (ABMTR) to determine relapse, disease-free survival, overall survival, and prognostic factors in this group of patients. Detailed records from the ABMTR on 414 patients with Hodgkin's disease in first relapse (n = 295) or second complete remission (CR) (n = 119) receiving an autotransplant from 1989 to 1995 were reviewed. Median age was 29 (range, 7-64) years. Median time from diagnosis to relapse was 18 (range, 6-219) months; median time from relapse to transplant was 5 (range, <1-215) months. Most patients received high-dose chemotherapy without total body irradiation for conditioning (n = 370). The most frequently used high-dose regimen was cyclophosphamide, BCNU, VP-16 (CBV) (n = 240). The graft consisted of bone marrow (n = 246), blood stem cells (n = 112), or both (n = 56). Median follow-up was 46 (range, 5-96) months. One hundred-day mortality (95% confidence interval) was 7 (5-9)%. One hundred and sixty-five of 295 patients (56%) transplanted in relapse achieved CR after autotransplantation. Of these, 61 (37%) recurred. Twenty-four of 119 patients (20%) transplanted in CR recurred. The probability of disease-free survival at 3 years was 46 (40-52)% for transplants in first relapse and 64 (53-72)% for those in second remission (P < 0.001). Overall survival at 3 years was 58 (52-64)% after transplantation in first relapse and 75 (66-83)% after transplantation in second CR (P < 0.001). In multivariate analysis, Karnofsky performance score <90% at transplant, abnormal serum LDH at transplant, and chemotherapy resistance were adverse prognostic factors for outcome. Progression of Hodgkin's disease accounted for 69% of all deaths. Autotransplantation should be considered for patients with Hodgkin's disease in first relapse or second remission. Future investigations should focus on strategies designed to decrease relapse after autotransplantation, particularly in patients at high risk for relapse.

Original languageEnglish (US)
Pages (from-to)387-396
Number of pages10
JournalBone Marrow Transplantation
Volume27
Issue number4
DOIs
StatePublished - Mar 20 2001

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Keywords

  • Autotransplant
  • Hodgkin's disease
  • Relapse
  • Second complete remission

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Lazarus, H. M., Loberiza, F. R., Zhang, M. J., Armitage, J. O., Ballen, K. K., Bashey, A., Bolwell, B. J., Burns, L. J., Freytes, C. O., Gale, R. P., Gibson, J., Herzig, R. H., LeMaistre, C. F., Marks, D., Mason, J., Miller, A. M., Milone, G. A., Pavlovsky, S., Reece, D. E., ... Horowitz, M. M. (2001). Autotransplants for Hodgkin's disease in first relapse or second remission: A report from the autologous blood and marrow transplant registry (ABMTR). Bone Marrow Transplantation, 27(4), 387-396. https://doi.org/10.1038/sj.bmt.1702796