Long-term results of blood and marrow transplantation for Hodgkin's lymphoma

Purpose : To evaluate the long-term outcome after allogeneic (allo) and aut ologous (auto) blood or marrow transplantation (BMT) in patients with relap sed or refractory Hodgkin's lymphoma (HL). Patients and Methods: We analyzed the outcome of 157 consecutive patients w ith relapsed or refractory HL, who underwent BMT between March 1985 and Apr il 1998. Patients less than or equal to. age 55 with HLA-matched siblings w ere prioritized toward allo BMT. The median age was 28 years (range, 13 to 52 years) for the 53 allo patients and 30.5 years (range, 11 to 62 years) f or the 104 auto patients. Results: The median follow-up after BMT for surviving patients was 5.1 year s (range, 1 to 13.8 years). For the entire group, the probabilities of even t-free survival (EFS) and relapse at 10 years were 26% (95% confidence inte rval [Cl], 18% to 33%) and 58% (95% Cl, 48% to 69%), respectively. Accordin g to multivariate analysis, disease status before BMT (sensitive relapse if responding to conventional-dose therapy or resistant disease if not) (haza rd ratio [HR] = 0.39, P <.0001) and date of BMT (HR = 0.93, P =.004) were i ndependent predictors of EFS, whereas only disease status (HR = 0.35, P <.0 001) influenced relapse. There was a trend for probability of relapse in se nsitive patients to be less after allo BMT at 34% (range, 8% to 59%) versus 51% (range, 36% to 67%) for the auto patients (HR = 0.51, P =.17). There w as a continuing risk of relapse or secondary acute myeloid leukemic (AML)/m yelodysplastic syndrome (MDS) for 12 years after auto BMT, whereas there we re no cases of secondary AML/MDS or relapses beyond 3 years after allo BMT. Conclusion: There seems to be a clinical graft-versus-HL effect associated with allo BMT. Allo BMT for HL also seems to have a lower risk of secondary AML/MDS than auto BMT. Thus, allo BMT warrants continued study in HL. J Cl in Oncol 19:4314-4321. (C) 2001 by American Society of Clinical Oncology.