Autotransplants for Hodgkin's disease in patients never achieving remission: A report from the autologous blood and marrow transplant registry

Purpose: Hodgkin's disease patients who never achieve complete remission wi th conventional chemotherapy (ie, those with primary induction failure) hav e a poor prognosis. Some subjects who receive high-dose therapy with autolo gous hematopoietic progenitor-cell infusion experience prolonged progressio n-free survival. Patients and Methods: Detailed records from the Autologous Blood and Marrow Transplant Registry (ABMTR) on 122 Hodgkin's disease patients who failed t o achieve complete remission after one or more conventional therapy regimen s and subsequently received an autotransplant between 1989 and 1995 were re viewed. Results: Median age was 27 years (range, 7 to 57 years). Median time from d iagnosis to transplantation was 14 months (range, 5 to 38 months). Most pat ients received high-dose chemotherapy without radiation for pretransplantat ion conditioning (n = 107). The regimen most frequently used was cyclophosp hamide, carmustine, and etoposide (n = 47), Fifteen patients received total -body irradiation (n = 15). The graft consisted of bone marrow (n = 86), bl ood stem cells (n = 25), or both (n = 11). The 100-day mortality was 12% (9 5% confidence interval, 7% to 19%), Sixty patients (50%) were considered to have achieved complete remission after autotransplantation; 37 of these ha d negative imaging studies, whereas scan abnormalities of unknown significa nce persisted in 23 patients. Twenty-seven patients (22%) had no response o r progressive disease after transplantation. Probabilities of progression-f ree and overall survival at 3 years were 38% (95% confidence interval, 28% to 48%) and 50% (95% confidence interval, 39% to 60%), respectively. In mul tivariate analysis, "B" symptoms at diagnosis and poor performance score at transplantation were adverse prognostic factors for outcome. Conclusion: Autotransplants should be considered for patients with Hodgkin' s disease who do not achieve complete remission with conventional therapy. (C) 1999 by American Society of Clinical Oncology.