Intensive therapy with autologous stem cell transplantation as first-line therapy in poor-risk Hodgkin's disease and analysis of predictive factors of outcome

The value of high-dose therapy with autologous stem cell transplantation as first-line therapy in poor prognosis Hodgkin's disease is controversial an d we report the results of evaluation of twenty-six patients who were selec ted for this procedure from February 1989 to July 1994. They were all patie nts with stage IV at diagnosis with at least two other unfavourable charact eristics, i.e. B symptoms, mediastinal mass greater than 0.45 of the thorac ic diameter, two or more extranodal sites, bone marrow involvement, inguina l node involvement, serum lactic dehydrogenase greater than 400 IU/L, or lo w hematocrit. At the time of transplantation, 19 patients were in complete remission and 10 were in partial remission greater than or equal to 50%. Pr ocedure-related mortality in the first 90 days post-graft was 7% overall. O f the 24 evaluable patients, 22 (92%) were assessed as complete responders, and 2 (8%) had progression of disease at 6 months. The actuarial overall s urvival (OS), disease-free survival (DFS) and event-free survival (EFS) at 5 years were 69%, 79% and 58%, respectively. The Cox proportional hazards m odel was used to assess prognostic factors. In univariate analysis only one prognostic factor was found to be significantly associated with improved D FS, i.e. low serum lactic dehydrogenase (LDH) (DFS at 5 years : 92% if LDH < 400 IU/L vs 44% if LDH 400 IU/L, P = 0.007), DFS rates between first comp lete remission and first partial remission groups were not significantly di fferent (DFS at 5 years: 87% vs 66%, p = 0.15). These first results are enc ouraging but randomized studies are needed.