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Hodgkin's Disease

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 volume 27, pages 387–396 (2001)Cite this article

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. Bone Marrow Transplantation (2001) 27, 387–396.

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Acknowledgements

This study was supported, in part, by Public Health Service Grant No. P30-CA43703 from the National Cancer Institute and by Public Health Service Grants Nos P01-CA40053 and U24-CA76518 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Heart, Lung and Blood Institute of the US Department of Health and Human Services; and by grants from Amgen, Inc.; Anonymous; Baxter Fenwal; Berlex Laboratories; Blue Cross and Blue Shield Association; Lynde and Harry Bradley Foundation; Bristol-Myers Squibb Oncology; Cell Therapeutics; Center for Advanced Studies in Leukemia; Chimeric Therapies; Chiron Therapeutics; COBE BCT Inc.; Eleanor Naylor Dana Charitable Trust; Deborah J Dearholt Memorial Fund; Empire Blue Cross Blue Shield; Eppley Foundation for Research; Fromstein Foundation; Fujisawa Healthcare, Inc.; Genentech, Inc.; Hoechst Marion Roussel; Horizon Medical Products; Human Genome Sciences; IDEC Pharmaceuticals; Immunex Corporation; IMPATH/BIS; IntraBiotics Pharmaceuticals; Kaiser Permanente; Kettering Family Foundation; Kirin Brewery Company; Robert J Kleberg, Jr and Helen C Kleberg Foundation; Herbert H Kohl Charities; LifeTrac/ Allianz; The Liposome Company; Nada and Herbert P Mahler Charities; Market Certitude; Mayer Ventures; MDS Nordian; MedImmune, Inc.; Milliman & Robertson, Inc.; Milstein Family Foundation; Miltenyi Biotech; Milwaukee Foundation/Elsa Schoeneich Research Fund; Mutual of Omaha; Nexell Therapeutics; NeXstar Pharmaceuticals, Inc; Samuel Roberts Noble Foundation; Novartis Pharmaceuticals; Orphan Medical; Ortho Biotech, Inc.; John Oster Family Foundation; Jane and Lloyd Pettit Foundation; Pfizer, Inc.; Pharmacia and Upjohn; Principal Life Insurance Company; Protide Pharmaceuticals; RGK Foundation; Rhône-Poulenc Rorer Pharmaceuticals, Inc.; Roche Laboratories; SangStat Medical Corporation; Schering AG; Schering-Plough Oncology; Searle; SmithKline Beecham Pharmaceutical; Stackner Family Foundation; The Starr Foundation; StemCell Technologies; SyStemix; Therakos; TheraTechnologies; United Resource Networks; US Oncology; and Wyeth-Ayerst Laboratories.

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Authors and Affiliations

  1. Department of Medicine, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA

    HM Lazarus

  2. Lymphoma Working Committee of the Autologous Blood and Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    FR Loberiza Jr, M-J Zhang, JD Rizzo & MM Horowitz

  3. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA

    JO Armitage & JM Vose

  4. Bone Marrow Transplant Program, University of Massachusetts Medical Center, Worcester, Massachusetts, USA

    KK Ballen

  5. Division of Hematology/Oncology, University of California, San Diego, California, USA

    A Bashey

  6. Bone Marrow Transplant Program, Cleveland Clinic Foundation, Cleveland, Ohio, USA

    BJ Bolwell

  7. Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA

    LJ Burns

  8. Division of Hematology/Oncology, University of Texas Health Science Center, San Antonio, Texas, USA

    CO Freytes

  9. Center for Advanced Studies in Leukemia, Los Angeles, California, USA

    RP Gale

  10. Haematology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    J Gibson

  11. James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA

    RH Herzig

  12. Texas Transplant Institute, San Antonio, Texas, USA

    CF LeMaistre

  13. Bone Marrow Transplant Unit, Bristol Royal Hospital for Sick Children, Bristol, UK

    D Marks

  14. Scripps Clinic and Research Foundation, La Jolla, California, USA

    J Mason

  15. Bone Marrow Transplant Program, Tulane University Medical Center, New Orleans, Louisiana, USA

    AM Miller

  16. Bone Marrow Transplant Program, Fundaleu, Buenos Aires, Argentina

    GA Milone & S Pavlovsky

  17. Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA

    DE Reece

  18. Section of Hematology/Oncology, University of Illinois, Chicago, Illinois, USA

    K van Besien

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  1. HM Lazarus
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  2. FR Loberiza Jr
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  17. GA Milone
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  19. DE Reece
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  22. JM Vose
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  23. MM Horowitz
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Lazarus, H., Loberiza, F., Zhang, MJ. et al. Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR). Bone Marrow Transplant 27, 387–396 (2001). https://doi.org/10.1038/sj.bmt.1702796

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