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Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin's lymphoma: identification of prognostic factors predicting outcome.
Robinson, Stephen P Sureda, Anna Canals, Carmen Russell, Nigel Caballero, Dolores Bacigalupo, Andrea Iriondo, Arturo Cook, Gordon Pettitt, Andrew Socie, Gerard
Robinson, Stephen P
Sureda, Anna
Canals, Carmen
Russell, Nigel
Caballero, Dolores
Bacigalupo, Andrea
Iriondo, Arturo
Cook, Gordon
Pettitt, Andrew
Socie, Gerard
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Abstract
BACKGROUND: The role of reduced intensity conditioning allogeneic stem transplantation (RICalloSCT) in the management of patients with Hodgkin's lymphoma remains controversial. DESIGN AND METHODS: To further define its role we have conducted a retrospective analysis of 285 patients with HL who underwent a RICalloSCT in order to identify prognostic factors that predict outcome. Eighty percent of patients had undergone a prior autologous stem cell transplantation and 25% had refractory disease at transplant. RESULTS: Non-relapse mortality was associated with chemorefractory disease, poor performance status, age >45 and transplantation before 2002. For patients with no risk factors the 3-year non-relapse mortality rate was 12.5% compared to 46.2% for patients with 2 or more risk factors. The use of an unrelated donor had no adverse effect on the non-relapse mortality. Acute graft versus host disease (aGVHD) grades II-IV developed in 30% and chronic GVHD in 42%. The development of cGVHD was associated with a lower relapse rate. The disease progression rate at one and five years was 41% and 58.7% respectively and was associated with chemorefractory disease and extent of prior therapy. Donor lymphocyte infusions were administered to 64 patients for active disease of whom 32% showed a clinical response. Eight out of 18 patients receiving donor lymphocyte infusions alone had clinical responses. Progression-free and overall survival were both associated with performance status and disease status at transplant. Patients with neither risk factor had a 3-year PFS and overall survival of 42% and 56% respectively compared to 8% and 25% for patients with one or more risk factors. Relapse within six months of a prior autologous transplant was associated with a higher relapse rate and a lower progression-free. CONCLUSIONS: This analysis identifies important clinical parameters that may be useful in predicting the outcome of RICaIICalloSCT in Hodgkin's lymphoma.
Authors
Robinson, Stephen P
Sureda, Anna
Canals, Carmen
Russell, Nigel
Caballero, Dolores
Bacigalupo, Andrea
Iriondo, Arturo
Cook, Gordon
Pettitt, Andrew
Socie, Gerard
Bonifazi, Francesca
Bosi, Alberto
Michallet, Mauricette
Liakopoulou, Effie F
Maertens, Johan
Passweg, Jakob
Clark, Fiona
Martino, Rodrigo
Schmitz, Norbert
Sureda, Anna
Canals, Carmen
Russell, Nigel
Caballero, Dolores
Bacigalupo, Andrea
Iriondo, Arturo
Cook, Gordon
Pettitt, Andrew
Socie, Gerard
Bonifazi, Francesca
Bosi, Alberto
Michallet, Mauricette
Liakopoulou, Effie F
Maertens, Johan
Passweg, Jakob
Clark, Fiona
Martino, Rodrigo
Schmitz, Norbert
Description
Date
2009-02
Publisher
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Keywords
Hodgkin's Lymphoma
Type
Article
Citation
Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin's lymphoma: identification of prognostic factors predicting outcome. 2009, 94 (2):230-8 Haematologica