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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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Related in: MedlinePlus

Kaplan–Meier estimates of progression-free survival for patients with refractory Hodgkin lymphoma stratified by the number of the following risk factors: disease status at transplant worse than CR, and two or more prior salvage therapy lines
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Fig5: Kaplan–Meier estimates of progression-free survival for patients with refractory Hodgkin lymphoma stratified by the number of the following risk factors: disease status at transplant worse than CR, and two or more prior salvage therapy lines

Mentions: Among the patients with refractory disease, univariate analysis revealed that worse OS was associated with more than one versus one salvage chemotherapy line prior to autoHCT (5-year OS estimates 45 vs. 89 %; p = 0.001), age ≥45 versus <45 years (5-year OS estimates 43 vs. 82 %; p = 0.035) and less than CR versus CR at transplant (5-year OS estimates 69 vs. 97 %; p = 0.010). Poor PFS was associated with more than one versus one salvage chemotherapy line prior to autoHCT (5-year estimates 37 vs. 86 %; p < 0.001) and less than CR versus CR at transplant (61 vs. 93 %; p = 0.003). In multivariate analysis, the number of salvage chemotherapy lines and disease status at transplant impacted both OS and PFS (Table 4). Consequently, patients with refractory disease were divided into two groups according to the number of identified independent unfavorable factors for outcome (0–1 vs. 2). The median PFS was not reached for patients with 0–1 risk factor (n = 33), compared to 11 months for patients with two risk factors (n = 10) (p < 0.001) (Fig. 5).Fig. 5


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 refractory Hodgkin lymphoma stratified by the number of the following risk factors: disease status at transplant worse than CR, and two or more prior salvage therapy lines
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Kaplan–Meier estimates of progression-free survival for patients with refractory Hodgkin lymphoma stratified by the number of the following risk factors: disease status at transplant worse than CR, and two or more prior salvage therapy lines
Mentions: Among the patients with refractory disease, univariate analysis revealed that worse OS was associated with more than one versus one salvage chemotherapy line prior to autoHCT (5-year OS estimates 45 vs. 89 %; p = 0.001), age ≥45 versus <45 years (5-year OS estimates 43 vs. 82 %; p = 0.035) and less than CR versus CR at transplant (5-year OS estimates 69 vs. 97 %; p = 0.010). Poor PFS was associated with more than one versus one salvage chemotherapy line prior to autoHCT (5-year estimates 37 vs. 86 %; p < 0.001) and less than CR versus CR at transplant (61 vs. 93 %; p = 0.003). In multivariate analysis, the number of salvage chemotherapy lines and disease status at transplant impacted both OS and PFS (Table 4). Consequently, patients with refractory disease were divided into two groups according to the number of identified independent unfavorable factors for outcome (0–1 vs. 2). The median PFS was not reached for patients with 0–1 risk factor (n = 33), compared to 11 months for patients with two risk factors (n = 10) (p < 0.001) (Fig. 5).Fig. 5

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