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Prognostic factors and long-term outcome of autologous haematopoietic stem cell transplantation following a uniform-modified BEAM-conditioning regimen for patients with refractory or relapsed Hodgkin lymphoma: a single-center experience.

Czyz A, Lojko-Dankowska A, Dytfeld D, Nowicki A, Gil L, Matuszak M, Kozlowska-Skrzypczak M, Kazmierczak M, Bembnista E, Komarnicki M - Med. Oncol. (2013)

Bottom Line: The median PFS for patients with >1 risk factor in the relapsed and refractory setting was 5 and 11 months, respectively, in comparison with the median PFS not reached for patients with 0-1 risk factor in both settings.We conclude that high proportion of patients with relapsed/refractory HL can be cured with autoHCT.However, the presence of two or more risk factors helps to identify poor prognosis patients who may benefit from novel treatment strategies.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, Poznan University of Medical Sciences, Szamarzewskiego 84, 61-569 Poznan, Poland. aczyz@onet.eu

ABSTRACT
Despite the well-defined role of autologous haematopoietic stem cell transplantation (autoHCT) in the treatment of patients with relapsed or refractory Hodgkin lymphoma (HL), relapse remains the main cause of transplant failure. We retrospectively evaluated long-term outcome and prognostic factors affecting survival of 132 patients with refractory (n = 89) or relapsed HL (n = 43) treated with autoHCT following modified BEAM. With a median follow-up of 68 months, the 10-year overall survival (OS) and progression-free survival (PFS) were 76 and 66 %, respectively. The 10-year cumulative incidence of second malignancies was 7 %. In multivariate analysis, age ≥45 years, more than one salvage regimens and disease status at transplant worse than CR were factors predictive for poor OS. In relapsed HL, age at transplant, response duration (<12 vs. ≥12 months) and the number of salvage regimens were independent predictors for PFS. In the refractory setting, disease status at autoHCT and the number of salvage regimens impacted PFS. The number of risk factors was inversely correlated with PFS in both relapsed and refractory HL (p = 0.003 and <0.001, respectively). The median PFS for patients with >1 risk factor in the relapsed and refractory setting was 5 and 11 months, respectively, in comparison with the median PFS not reached for patients with 0-1 risk factor in both settings. We conclude that high proportion of patients with relapsed/refractory HL can be cured with autoHCT. However, the presence of two or more risk factors helps to identify poor prognosis patients who may benefit from novel treatment strategies.

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Kaplan–Meier estimates of progression-free survival for patients with relapsed Hodgkin lymphoma stratified by the number of the following risk factors: duration of remission <12 months, age at transplant ≥45 years, and two or more prior salvage therapy lines
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Fig4: Kaplan–Meier estimates of progression-free survival for patients with relapsed Hodgkin lymphoma stratified by the number of the following risk factors: duration of remission <12 months, age at transplant ≥45 years, and two or more prior salvage therapy lines

Mentions: Within the group of patients with relapsed disease, univariate analysis revealed that poor OS was associated with age ≥45 years versus <45 years at transplant (5-year OS estimates 37.5 vs. 79.5 %; p = 0.003) and ALC ≤500 versus. >500/μl at 15 ± 1 day after autoHCT (5-year OS estimates 62 vs. 100 %; p = 0.037). In addition, duration of remission and disease status at transplant tended to impact OS (p = 0.082 and 0.080, respectively). PFS was adversely impacted by more than one versus one salvage chemotherapy line prior to transplant (5-year PFS estimates 43 vs. 75 %; p = 0.027), the duration of remission <12 versus ≥12 months (5-year PFS estimates 49 vs. 78 %; p = 0.025), and age ≥45 years versus <45 years at transplant (5-year PFS estimates 37 vs. 71 %; p = 0.073). In multivariate analysis, age at transplant remained significant for both OS and PFS. Additionally, the number of salvage chemotherapy lines and the length of remission were independently prognostic for PFS (Table 4). Having found age ≥45 years, more than one salvage chemotherapy line and duration of remission <12 months as the independent predictors of PFS for patients with relapsed disease, we divided those patients into two groups according to the number of identified independent unfavorable factors for outcome (0–1 vs. 2–3). The median PFS was not reached for patients with 0–1 risk factors (n = 64), compared to 5 months for patients with 2–3 risk factors (n = 25) (p = 0.003) (Fig. 4). Fig. 4


Prognostic factors and long-term outcome of autologous haematopoietic stem cell transplantation following a uniform-modified BEAM-conditioning regimen for patients with refractory or relapsed Hodgkin lymphoma: a single-center experience.

Czyz A, Lojko-Dankowska A, Dytfeld D, Nowicki A, Gil L, Matuszak M, Kozlowska-Skrzypczak M, Kazmierczak M, Bembnista E, Komarnicki M - Med. Oncol. (2013)

Kaplan–Meier estimates of progression-free survival for patients with relapsed Hodgkin lymphoma stratified by the number of the following risk factors: duration of remission <12 months, age at transplant ≥45 years, and two or more prior salvage therapy lines
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3755217&req=5

Fig4: Kaplan–Meier estimates of progression-free survival for patients with relapsed Hodgkin lymphoma stratified by the number of the following risk factors: duration of remission <12 months, age at transplant ≥45 years, and two or more prior salvage therapy lines
Mentions: Within the group of patients with relapsed disease, univariate analysis revealed that poor OS was associated with age ≥45 years versus <45 years at transplant (5-year OS estimates 37.5 vs. 79.5 %; p = 0.003) and ALC ≤500 versus. >500/μl at 15 ± 1 day after autoHCT (5-year OS estimates 62 vs. 100 %; p = 0.037). In addition, duration of remission and disease status at transplant tended to impact OS (p = 0.082 and 0.080, respectively). PFS was adversely impacted by more than one versus one salvage chemotherapy line prior to transplant (5-year PFS estimates 43 vs. 75 %; p = 0.027), the duration of remission <12 versus ≥12 months (5-year PFS estimates 49 vs. 78 %; p = 0.025), and age ≥45 years versus <45 years at transplant (5-year PFS estimates 37 vs. 71 %; p = 0.073). In multivariate analysis, age at transplant remained significant for both OS and PFS. Additionally, the number of salvage chemotherapy lines and the length of remission were independently prognostic for PFS (Table 4). Having found age ≥45 years, more than one salvage chemotherapy line and duration of remission <12 months as the independent predictors of PFS for patients with relapsed disease, we divided those patients into two groups according to the number of identified independent unfavorable factors for outcome (0–1 vs. 2–3). The median PFS was not reached for patients with 0–1 risk factors (n = 64), compared to 5 months for patients with 2–3 risk factors (n = 25) (p = 0.003) (Fig. 4). Fig. 4

Bottom Line: The median PFS for patients with >1 risk factor in the relapsed and refractory setting was 5 and 11 months, respectively, in comparison with the median PFS not reached for patients with 0-1 risk factor in both settings.We conclude that high proportion of patients with relapsed/refractory HL can be cured with autoHCT.However, the presence of two or more risk factors helps to identify poor prognosis patients who may benefit from novel treatment strategies.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, Poznan University of Medical Sciences, Szamarzewskiego 84, 61-569 Poznan, Poland. aczyz@onet.eu

ABSTRACT
Despite the well-defined role of autologous haematopoietic stem cell transplantation (autoHCT) in the treatment of patients with relapsed or refractory Hodgkin lymphoma (HL), relapse remains the main cause of transplant failure. We retrospectively evaluated long-term outcome and prognostic factors affecting survival of 132 patients with refractory (n = 89) or relapsed HL (n = 43) treated with autoHCT following modified BEAM. With a median follow-up of 68 months, the 10-year overall survival (OS) and progression-free survival (PFS) were 76 and 66 %, respectively. The 10-year cumulative incidence of second malignancies was 7 %. In multivariate analysis, age ≥45 years, more than one salvage regimens and disease status at transplant worse than CR were factors predictive for poor OS. In relapsed HL, age at transplant, response duration (<12 vs. ≥12 months) and the number of salvage regimens were independent predictors for PFS. In the refractory setting, disease status at autoHCT and the number of salvage regimens impacted PFS. The number of risk factors was inversely correlated with PFS in both relapsed and refractory HL (p = 0.003 and <0.001, respectively). The median PFS for patients with >1 risk factor in the relapsed and refractory setting was 5 and 11 months, respectively, in comparison with the median PFS not reached for patients with 0-1 risk factor in both settings. We conclude that high proportion of patients with relapsed/refractory HL can be cured with autoHCT. However, the presence of two or more risk factors helps to identify poor prognosis patients who may benefit from novel treatment strategies.

Show MeSH
Related in: MedlinePlus