Abstract
We have analyzed overall survival (OS-REL), progression-free survival (PFS-REL) and the clinical variables influencing the long-term outcome for patients with Hodgkin′s lymphoma (HL) who relapse after an autologous stem cell transplantation (ASCT). From 639 patients autografted for HL [383 males (60%) and 256 (40%) females, median age of 30 (1–66) years] reported to the GEL/TAMO Cooperative Group between January/1984 and January/2003, 175 patients (27%) relapsed at a median time of 10 (4 – 125) months [median (range)] after ASCT. They were 97 males (56%) and 78 (44%) females with a median age of 28 (10 – 66) [median (range)] years at transplantation. Sixty-three patients were autografted in complete remission, 73 in sensitive relapse and 31 in resistant relapse. One hundred and sixty three patients (94%) received different chemotherapy (CT) protocols as conditioning regimen and 12 patients (6%), CT plus total body irradiation. At relapse, 94 patients (53%) presented with advanced stages (III-IV), 49 patients (28%) with B symptoms and 19 (11%) with bulky disease. Relapse was extranodal in 45% of the patient population. Ten percent of the patients had a poor performance status (ECOG ≥2) and 37 patients (22%) had a hemoglobin (Hb) level < 100 g/l at relapse. Thirty four patients (20%) received no further therapy, 107 (60%) received different CT +/− radiotherapy and the remaining 34 patients (20%) were treated with a second stem cell transplantation (13 patients, an ASCT and 21 an allogeneic transplantation). OS-REL and PFS-REL were of 35% ± 4% and 23% ± 4% at 3 years, respectively. Advanced clinical stage (III-IV) at relapse [relative risk (RR) 4.4, 95% confidence interval (CI) (1.7 – 10.8), p = 0.002] and an interval between ASCT and relapse < 12 months [RR 2.4, 95%CI (1.1 – 5.0), p = 0.03] were independent adverse prognostic factors for PFS-REL. Advanced clinical stage at relapse [RR 4.4, 95%CI (1.4 – 14.4), p = 0.012], extranodal disease [RR 2.4, 95%CI (1.3 – 15.4), p = 0.02] and a Hb level < 100 g/l at relapse [RR 3.4, 95%CI (2.0 – 10.4), p = 0.03] were significant adverse prognostic factors for OS-REL. Although the long-term outcome of HL patients who relapse after ASCT is poor, results are better in patients with late relapses and localized disease. Moreover, a minority of the patients can become long-term progression-free survivors after relapse. The identification and construction of prognostic sub-groups according to the number of risk factors may be useful to develop risk-adapted therapeutic strategies.
Prognostic factors affecting long-term outcome after stem cell transplantation in Hodgkin's lymphoma autografted after a first relapse