TREATMENT-RELATED DEATHS AND 2ND CANCER RISK AFTER AUTOLOGOUS STEM-CELL TRANSPLANTATION FOR HODGKINS-DISEASE

Autologous stem-cell transplantation has become a widely used therapy in Hodgkin's disease (HD). To appreciate the early and late risks asso ciated with this procedure, its lethal toxicity and effects on the inc idence of secondary cancers were studied. Data related to 467 French p atients grafted from 1982 to 1995 for primary sensitive disease (PSD, 22%), primary refractory disease (PRD, 18%), first relapse (R1, 45%), or subsequent relapses (R2, 15%) were analyzed. Grafted patients (PSD, PRD, and R1; n = 393) were matched (3 controls for 1 case) on age, ge nder, clinical stage, B symptoms, and time at risk with 1179 conventio nally treated patients issued from international databases. The propor tional hazards (Cox) model was used to assess-relative risks (RR). Amo ng grafted patients, 8% died of toxicity related to the procedure, and 18 secondary cancers occurred leading to a 5-year cumulative incidenc e rate of 8.9%. In this series, risk factors for second cancer were ag e greater than or equal to 40 years (RR = 3.73, P = .007) and the use of peripheral blood stem cells as source of graft (RR = 3.10, P = .03) . Among grafted and matched ungrafted patients, risk factors for the d evelopment of secondary cancer were age greater than or equal to 40 ye ars (RR = 2.90, P < .001), relapse versus no relapse (RR = 5.22, P = . 006), PRD versus other patients (RR = 3.86, P =.033), and grafted vers us ungrafted patients (RR = 2.04, P = .024). Solid tumors were more fr equent in grafted than in ungrafted patients (RR = 5.19, P = .001) alt hough the incidence of myelodysplasia and acute myeIoid leukemia was s imilar in the two groups. We conclude that high-dose chemotherapy admi nistered as first-line treatment or after relapse is associated with a n acceptable toxic death rate. The risk of secondary myelodysplasia or acute myeloid leukemia is not significantly increased after autologou s stem-cell transplantation for HD, whereas an increased risk of solid tumors exists. The peripheral blood stem-cell-associated risk of seco ndary cancer among grafted patients needs further investigations. (C) 1998 by The American Society of Hematology.