Autologous stem-cell transplantation for Hodgkin's disease: Results and prognostic factors in 494 patients from the Grupo Espanol de Linfomas/Transplante Autolog de Medula Osea Spanish Cooperative Group
A. Sureda et al., Autologous stem-cell transplantation for Hodgkin's disease: Results and prognostic factors in 494 patients from the Grupo Espanol de Linfomas/Transplante Autolog de Medula Osea Spanish Cooperative Group, J CL ONCOL, 19(5), 2001, pp. 1395-1404
Purpose: To analyze clinical outcome and significant prognostic factors for
overall (OS) and time to treatment failure (TTF) in a group of 494 patient
s with Hodgkin's disease (HD) undergoing autologous stem-cell transplantati
on (ASCT).
Patients and Methods: Detailed records from the Grupo Espanol de Linfomas/T
ransplante Autologo de Medula Osea Spanish Cooperative Group Database on 49
4 HD patients who received an ASCT between January 1984 and May 1998 were r
eviewed. Two hundred ninety-eight males and 196 females with a median age o
f 27 years (range, 1 to 63 years) received autografts while in complete rem
ission (n = 203) or when they had sensitive disease (n = 206) or resistant
disease (n = 75) at a median time of 26 months (range, 4 to 259 months) aft
er diagnosis. Most patients received high-dose chemotherapy without radiati
on for conditioning (n = 443). The graft consisted of bone marrow (n = 244)
or peripheral blood (n = 250).
Results: The 100-day mortality rate was 9%. The 5-year actuarial TTF and OS
rates were 45.0% (95% confidence interval [CI], 39.5% to 50.5%) and 54.5%
(95% CI, 48.4% to 60.6%), respectively. In multivariate analysis, the prese
nce of active disease at transplantation, transplantation before 1992, and
two or more lines of therapy before transplantation were adverse prognostic
factors for outcome. Sixteen patients developed a secondary malignancy (5-
year cumulative incidence of 4.3%) alter transplantation, Adjuvant radiothe
rapy before transplantation, the use of total-body irradiation (TBI) in the
conditioning regimen, and age greater than or equal to 40 years were found
to be predictive factors for the development of second cancers after ASCT.
Conclusion: ASCT achieves long-term disease-free survival in HD patients. D
isease status before ASCT is the most important prognostic factor for final
outcome; thus, transplantation should be considered in early stages of the
disease. TBI must be avoided in the conditioning regimen because of a sign
ificantly higher rate of late complications, including secondary malignanci
es. J Clin Oncol 19:1395-1404. (C) 2001 by American Society of Clinical Onc
ology.