High-dose therapy with peripheral blood stem cell transplantation for patients with relapsed or refractory Hodgkin's disease: long-term outcome and prognostic factors

From March 1986 to March 1998, 82 patients with relapsed or refractory Hodg kin's disease underwent high-dose chemotherapy (HDCT) with peripheral blood stem cell (PBSC) transplantation in our center. This is a retrospective an alysis of the long-term clinical outcome. There were 52 males and 30 female s with a median age of 32 years (range 18-59 years). Prior to transplantati on, 36 patients were in complete remission (CR), 34 in partial remission (P R), and 12 had refractory disease after salvage therapy. For HDCT, 78 patie nts were treated with CBV (cyclophosphamide, 6.0-6.8 g/m(2); etoposide, 1.0 -1.6 g/m(2); carmustine, 0.45-0.8 g/m(2)), while four patients received dif ferent regimens. Probability of freedom from progression (FFP), overall sur vival (OS), and event-free survival (EFS) at 5 years of the entire group wa s 63%, 61%, and 54%, respectively. Early mortality rate (less than or equal to 100 days) declined from 17% to 6% after 1992. Five patients died of lat e transplant-related complications (>100 days), including secondary lymphom a and leukemia in two patients. None of the refractory patients survived be yond 3.5 years. Multivariate analyses identified extranodal sites of diseas e at relapse and refractory disease status prior to transplantation as sign ificant prognostic factors for FFP, EFS, and OS. As we have shown in our st udy, remarkable progress was achieved in reducing early morbidity and morta lity over time, but this was associated with only a slight, not significant improvement of long-term outcome (OS 66% vs 57% at 5 years for patients un dergoing PBSC transplantation before and after 1992, P=0.26). Although the results as a whole are encouraging for chemosensitive patients, new therape utic strategies are needed to reduce toxicity and improve the clinical outc ome of patients, especially of those with a less favorable prognosis.