Autologous stem cell transplantation for high-risk Hodgkin's disease: improvement over time and impact of conditioning regimen

Background and Objectives. High-dose chemo/radio therapy with autologous st em cell support is increasingly being used in Hodgkin's disease (HD) patien ts who do not respond to or who relapse after conventional chemotherapy. In this work we analyze the results of 56 consecutive high-risk HD patients a utografted in our institution and the role of possible prognostic factors. Design and Methods. There were 34 males and 22 females with a median age of 31 years. At transplantation, 24 patients (43%) were in complete remission and 32 (57%) were autografted while with active disease. Twenty-nine patie nts were autografted before January 1993. Bone marrow was used as the sourc e of stem cells in 40 patients (71%) and peripheral blood (PB) in 16 (29%). Forty-five patients received chemotherapy-based conditioning regimens (40 CBV and 5 BEAM) while the remaining 11 received cyclophosphamide (Cy) and t otal body irradiation (TBI). Results. Two bone marrow transplantation (BMT) recipients did not engraft. Hematologic recovery was significantly faster in patients transplanted with PB progenitor cells. Early transplant-related mortality (early TRM) (befor e day 100 after transplantation) was 9%; it was higher in patients transpla nted before January 1993 than in patients transplanted afterwards (14% vs 4 %) and in patients receiving TBI (18% vs 7%), although these differences di d not reach statistical significance. Overall TRM (before and after day 100 ) was 14%. TBI-containing regimens significantly increased overall TRM (36% and 9%, p = 0.03). Actuarial 3.5-year overall survival (OS), event-free su rvival (EFS) and progression-free survival (PFS) were 57%, 58% and 65%, res pectively. On multivariable analysis, TBI containing regimens and transplan tation before 1993 significantly reduced OS and EFS. Interpretation and Conclusions. Our results confirm I that high-dose therap y followed by autologous stem cell transplantation is associated with susta ined PFS in a remarkable proportion of patients with HD unlikely to be cure d with standard chemotherapy. Results improved over time and TBI containing regimens bad a negative effect on post-transplant outcome. (C) 2000, Ferra ta Storti Foundation.