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Cancer. 2018 Feb 15;124(4):816-825. doi: 10.1002/cncr.31114. Epub 2017 Nov 10.

Long-term outcomes among 2-year survivors of autologous hematopoietic cell transplantation for Hodgkin and diffuse large b-cell lymphoma.

Author information

1
Divisions of Hematology and Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Pennsylvania.
2
Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
3
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
5
Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
6
Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
7
Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, California.
8
Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
9
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
10
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
11
St Jude Children's Research Hospital, Memphis, Tennessee.
12
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
13
Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland.
14
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
15
Tom Baker Cancer Center, Calgary, Alberta, Canada.
16
Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
17
Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
18
Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
19
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
20
Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts.
21
Department of Pediatric Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
22
Department of Pediatrics, Uniformed Services Industry of the Health Sciences, Bethesda, Maryland.
23
Division of Hematology, Ohio State University Medical Center, Columbus, Ohio.
24
University of Miami, Miami, Florida.
25
Department of Medical Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania.
26
Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
27
Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
28
Baylor University Medical Center, Dallas, Texas.
29
Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.
30
Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
31
Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
32
Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York.

Abstract

BACKGROUND:

Autologous hematopoietic cell transplantation (auto-HCT) is a standard therapy for relapsed classic Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL); however, long-term outcomes are not well described.

METHODS:

This study analyzed survival, nonrelapse mortality, late effects, and subsequent malignant neoplasms (SMNs) in 1617 patients who survived progression-free for ≥2 years after auto-HCT for cHL or DLBCL between 1990 and 2008. The median age at auto-HCT was 40 years; the median follow-up was 10.6 years.

RESULTS:

The 5-year overall survival rate was 90% (95% confidence interval [CI], 87%-92%) for patients with cHL and 89% (95% CI, 87%-91%) for patients with DLBCL. The risk of late mortality in comparison with the general population was 9.6-fold higher for patients with cHL (standardized mortality ratio [SMR], 9.6) and 3.4-fold higher for patients with DLBCL (SMR, 3.4). Relapse accounted for 44% of late deaths. At least 1 late effect was reported for 9% of the patients. A total of 105 SMNs were confirmed: 44 in the cHL group and 61 in the DLBCL group. According to a multivariate analysis, older age, male sex, a Karnofsky score < 90, total body irradiation (TBI) exposure, and a higher number of lines of chemotherapy before auto-HCT were risk factors for overall mortality in cHL. Risk factors in DLBCL were older age and TBI exposure. A subanalysis of 798 adolescent and young adult patients mirrored the outcomes of the overall study population.

CONCLUSIONS:

Despite generally favorable outcomes, 2-year survivors of auto-HCT for cHL or DLBCL have an excess late-mortality risk in comparison with the general population and experience an assortment of late complications. Cancer 2018;124:816-25. © 2017 American Cancer Society.

KEYWORDS:

Hodgkin lymphoma; autologous hematopoietic cell transplant; diffuse large B-cell lymphoma; late effects; nonrelapse mortality; survival

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