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Annals of Oncology 14:745-751, 2003
© 2003 European Society for Medical Oncology

Autologous stem cell transplantation for primary refractory Hodgkin’s disease: results and clinical variables affecting outcome

M. Constans1, A. Sureda1,+,§, M. J. Terol2, R. Arranz3, M. D. Caballero4, A. Iriondo5, I. Jarque6, E. Carreras7, J. M. Moraleda8, D. Carrera9, A. León10, A. López11, C. Albó12, J. Díaz-Mediavilla13, P. Fernández-Abellán14, J. C. García-Ruiz15, F. Hernández-Navarro16, R. Mataix17, J. Petit18, M. J. Pascual19, J. Rifón20, J. García-Conde2, J. M. Fernández-Rañada3, M. V. Mateos4, J. Sierra1 and E. Conde5

1 Hospital de la Santa Creu i Sant Pau, Barcelona; 2 Hospital Clínico, Valencia; 3 Hospital La Princesa, Madrid; 4 Hospital Clínco Universitario, Salamanca; 5 Hospital Marqués de Valdecilla, Santander; 6 Hospital La Fe, Valencia; 7 Hospital Clínic i Provincial, Barcelona; 8 Hospital Morales Messeguer, Murcia; 9 Hospital Central de Asturias, Oviedo; 10 Hospital de Jerez, Jerez de la Frontera; 11 Hospital Vall d’Herbrón, Barcelona; 12 Hospital Xeral-Cíes, Vigo; 13 Hospital Clínico San Carlos, Madrid; 14 Hospital Genal de Alicante, Alicante; 15 Hospital de Cruces, Baracaldo; 16 Hospital La Paz, Madrid; 17 Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria; 18 Institut Català d’Oncologia, L’Hospitalet de Llobregat; 19 Hospital Carlos Haya, Málaga; 20 Clínica Universitaria de Navarra, Pamplona

Received 23 October 2002; revised 8 January 2003; accepted 23 January 2003

Abstract

Background:

Patients with primary refractory Hodgkin’s disease (PR-HD) have a dismal prognosis when treated with conventional salvage chemotherapy. We analyzed time to treatment failure (TTF), overall survival (OS) and clinical variables influencing the outcome in patients undergoing autologous stem cell transplantation (ASCT) for PR-HD and reported to the Grupo Español de Linfomas/Trasplante Autólogo de Médula Ósea (GEL/TAMO).

Patients and methods:

Sixty-two patients, 41 males and 21 females with a median age of 27 years (range 13–55) were analyzed. Forty-two patients (68%) had advanced stage at diagnosis, 47 (76%) presented with B symptoms and 29 (47%) with a bulky mediastinal mass. Seventy-five percent of the patients had received more than one line of therapy before ASCT. Thirty-three patients received bone marrow as a source of hematopoietic progenitors, and 29 peripheral blood. Six patients were conditioned with high-dose chemotherapy plus total-body irradiation and 56 received chemotherapy-based protocols.

Results:

One-year transplantation-related mortality was 14% [95% confidence interval (CI) 6% to 23%]. Response rate at 3 months after ASCT was 52% [complete remission in 21 patients (34%), partial remission in 11 patients (18%)]. Actuarial 5-year TTF and OS were 15% (95% CI 5% to 24%) and 26% (95% CI 13% to 39%), respectively. The presence of B symptoms at ASCT was the only adverse prognostic factor significantly influencing TTF [relative risk (RR) 1.75, 95% CI 0.92–3.35, P = 0.08]. The presence of B symptoms at diagnosis (RR 2.08, 95% CI 0.90–4.79, P = 0.08), MOPP-like regimens as first-line therapy (RR 3.84, 95% CI 1.69–9.09, P = 0.001), bulky disease at ASCT (RR 2.79, 95% CI 0.29–6.03, P = 0.009) and two or more lines of therapy before ASCT (RR 2.24, 95% CI 0.95–5.27, P = 0.06) adversely influenced OS.

Conclusions:

In our experience, although overall results of ASCT in PR-HD patients are poor, one-quarter of the patients remain alive at 5 years. Despite this, other therapeutic strategies should be investigated in this group of patients to improve the outcome.

Key words: autologous stem cell transplantation, Hodgkin’s disease, induction failure


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