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Ann Oncol. 2014 Nov;25(11):2218-23. doi: 10.1093/annonc/mdu387. Epub 2014 Aug 22.

Chemoresistance can be overcome with high-dose chemotherapy and autologous stem-cell transplantation for relapsed and refractory Hodgkin lymphoma.

Author information

1
Leukemia/Bone Marrow Transplant Program of British Columbia and the Division of Hematology, British Columbia Cancer Agency and the University of British Columbia Center for Lymphoid Cancer Research and the Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada agerrie@bccancer.bc.ca.
2
Leukemia/Bone Marrow Transplant Program of British Columbia and the Division of Hematology, British Columbia Cancer Agency and the University of British Columbia.
3
Center for Lymphoid Cancer Research and the Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada.

Abstract

BACKGROUND:

High-dose therapy and autologous stem-cell transplant (HDT/ASCT) is the preferred treatment of chemosensitive relapsed/refractory Hodgkin lymphoma (HL). The role for HDT/ASCT in chemoresistant HL is less well defined. We evaluated long-term outcomes of relapsed/refractory HL patients whose disease was refractory to secondary chemotherapy preceding HDT/ASCT.

PATIENTS AND METHODS:

All HL patients who underwent HDT/ASCT in British Columbia for primary progression (PP, defined as progression within 3 months of initial therapy completion) or first relapse (REL1) were reviewed. Patients were grouped based on response to secondary chemotherapy as sensitive (S), resistant (R), and untested/unknown (U).

RESULTS:

A total of 256 patients underwent HDT/ASCT for PP (35%) or REL1 (65%) between 1985 and 2011. At median follow-up of 11.7 years, 58% were alive without HL, 36% relapsed; 6% died of transplant-related mortality, 3% secondary malignancies, and 3% unrelated causes. For PP/S, PP/R, and PP/U groups, 10-year FFS were 47%, 31%, and 38%; 10-year OS were 52%, 29%, and 37%, respectively. For REL1/S, REL1/R, and REL1/U groups, 10-year FFS were 64%, 51%, and 81%; 10-year OS were 71%, 59%, and 79%, respectively. In multivariate analysis, resistance to secondary chemotherapy predicted for post-transplant mortality in the PP (P = 0.04) but not REL1 (P = 0.16) groups.

CONCLUSION:

In this large uniformly treated cohort of HL patients with long-term follow-up, chemoresistance preceding HDT/ASCT was identified as a poor prognostic factor; however, this factor can be partially overcome by HDT/ASCT, resulting in cure in 30%-50% of patients. HDT/ASCT should therefore be considered in all transplant eligible patients, regardless of responsiveness to salvage chemotherapy.

KEYWORDS:

Hodgkin lymphoma; chemoresistance; refractory; relapsed; stem-cell transplant; therapy

PMID:
25149708
DOI:
10.1093/annonc/mdu387
[Indexed for MEDLINE]

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