High-dose chemotherapy and autologous stem cell transplantation for primary refractory or relapsed Hodgkin lymphoma: long-term outcome in the first 100 patients treated in Vancouver

• Published in: Blood 2005-08, Vol.106 (4), p.1473-1478
• Main Authors: Lavoie, Julye C., Connors, Joseph M., Phillips, Gordon L., Reece, Donna E., Barnett, Michael J., Forrest, Donna L., Gascoyne, Randy D., Hogge, Donna E., Nantel, Stephen H., Shepherd, John D., Smith, Clayton A., Song, Kevin W., Sutherland, Heather J., Toze, Cynthia L., Voss, Nicholas J.S., Nevill, Thomas J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - toxicity; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Canada; Cause of Death; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic Stem Cell Transplantation - mortality; Hodgkin Disease - complications; Hodgkin Disease - mortality; Hodgkin Disease - therapy; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Neoplasms, Second Primary - chemically induced; Neoplasms, Second Primary - mortality; Probability; Retrospective Studies; Salvage Therapy; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Autologous; Treatment Outcome
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2004-12-4689

Beginning in 1985, patients in British Columbia with Hodgkin lymphoma (HL) that was not controlled by conventional chemotherapy routinely underwent high-dose chemotherapy and autologous stem cell transplantation (HD-ASCT). Long-term complications of HD-ASCT have become apparent as more patients survive without recurrence of HL. Data were obtained retrospectively on the first 100 patients that underwent HD-ASCT for HL in Vancouver, focusing on relapse, treatment-related complications, and the occurrence of late events. Fifty-three patients remain alive (median follow-up, 11.4 years [range, 10.0-17.4 years]) with an overall survival (OAS) of 54% at 15 years. OAS was significantly better in patients in first relapse (67%) than in patients with primary refractory-induction failure (39%) and advanced disease (29%) (P = .002). The major cause of death was progression of HL (32% at 15 years). Treatment-related mortality, including death from second malignancy, was 17% at 15 years. Cumulative risk of a second malignancy was 9% at 15 years. Karnofsky performance status was at least 90% in 47 patients although hypogonadism (20 patients), hypothyroidism (12 patients), unusual infections (10 patients), anxiety or depression (7 patients), and cardiac disease (5 patients) were not uncommon in survivors. HD-ASCT can lead to durable remissions in relapsed or refractory HL with acceptable but definite late toxicity. The occurrence of late events necessitates lifelong medical surveillance. (Blood. 2005;106:1473-1478)