Long-term results of high-dose chemotherapy with autologous bone marrow or peripheral stem cell transplant as first salvage treatment for relapsed or refractory Hodgkin lymphoma: A single institution experience

Simonetta Viviani, Massimo Di Nicola, Valeria Bonfante, Antonio Di Stasi, Carmelo Carlo-Stella, Paola Matteucci, Michele Magni, Liliana Devizzi, Pinuccia Valagussa, Alessandro M. Gianni

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Abstract

The introduction of high-dose (HD) chemotherapy (CT) and autologous stem cell (ASCT) or bone marrow transplant (ABMT) in the last two decades has improved the prognosis of patients with refractory or relapsed Hodgkin lymphoma (HL) over conventional-dose salvage CT. To evaluate the outcome of adult patients with HL treated with HD CT and ASCT or ABMT after failure or relapse from first-line treatment with CT±radiotherapy, we report the results of a retrospective analysis in 82 consecutive patients given HD CT and autologous transplant as second-line therapy between October 1984 and December 2006. Thirty-two patients were given sequential high-dose cytoreductive therapy while 50 received other conventional induction regimens. Seventy-three patients with chemoresponsive disease underwent the myeloablative phase, while eight patients had progressive disease during cytoreductive CT. After a median follow-up of 73 months, the 10-year progression-free survival (PFS) and overall survival (OS) were 57 and 51, respectively. According to response to first-line treatment, PFS and OS were, respectively, 54 and 82 for patients with complete remission (CR) lasting 12 months or more; 49 and 51 for patients with CR less than 12 months; and 47 and 50 for patients who never achieved CR or progressed during first-line CT (induction failure). Response to cytoreductive CT significantly influenced outcome, with PFS and OS being, respectively, 56 and 68 vs. 44 and 47 (p0.009) in patients in CR versus patients not in CR after induction therapy. Treatment was well tolerated, and therapy related mortality was only 3.7. These long-term results confirm that HD CT and ASCT or ABMT was feasible, safe, and very effective. Therefore, this therapeutic strategy may represent an active salvage approach even in the unfavorable group of patients with induction failure.

Original languageEnglish
Pages (from-to)1251-1259
Number of pages9
JournalLeukemia and Lymphoma
Volume51
Issue number7
DOIs
Publication statusPublished - Jul 2010

Fingerprint

Salvage Therapy
Hodgkin Disease
Bone Marrow
Transplants
Drug Therapy
Disease-Free Survival
Therapeutics
Survival
Peripheral Blood Stem Cells
Remission Induction
Induction Chemotherapy
Autografts
Stem Cells

Keywords

  • clinical results
  • Lymphoma and Hodgkin disease
  • stem cell mobilization

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

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title = "Long-term results of high-dose chemotherapy with autologous bone marrow or peripheral stem cell transplant as first salvage treatment for relapsed or refractory Hodgkin lymphoma: A single institution experience",
abstract = "The introduction of high-dose (HD) chemotherapy (CT) and autologous stem cell (ASCT) or bone marrow transplant (ABMT) in the last two decades has improved the prognosis of patients with refractory or relapsed Hodgkin lymphoma (HL) over conventional-dose salvage CT. To evaluate the outcome of adult patients with HL treated with HD CT and ASCT or ABMT after failure or relapse from first-line treatment with CT±radiotherapy, we report the results of a retrospective analysis in 82 consecutive patients given HD CT and autologous transplant as second-line therapy between October 1984 and December 2006. Thirty-two patients were given sequential high-dose cytoreductive therapy while 50 received other conventional induction regimens. Seventy-three patients with chemoresponsive disease underwent the myeloablative phase, while eight patients had progressive disease during cytoreductive CT. After a median follow-up of 73 months, the 10-year progression-free survival (PFS) and overall survival (OS) were 57 and 51, respectively. According to response to first-line treatment, PFS and OS were, respectively, 54 and 82 for patients with complete remission (CR) lasting 12 months or more; 49 and 51 for patients with CR less than 12 months; and 47 and 50 for patients who never achieved CR or progressed during first-line CT (induction failure). Response to cytoreductive CT significantly influenced outcome, with PFS and OS being, respectively, 56 and 68 vs. 44 and 47 (p0.009) in patients in CR versus patients not in CR after induction therapy. Treatment was well tolerated, and therapy related mortality was only 3.7. These long-term results confirm that HD CT and ASCT or ABMT was feasible, safe, and very effective. Therefore, this therapeutic strategy may represent an active salvage approach even in the unfavorable group of patients with induction failure.",
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author = "Simonetta Viviani and {Di Nicola}, Massimo and Valeria Bonfante and {Di Stasi}, Antonio and Carmelo Carlo-Stella and Paola Matteucci and Michele Magni and Liliana Devizzi and Pinuccia Valagussa and Gianni, {Alessandro M.}",
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T1 - Long-term results of high-dose chemotherapy with autologous bone marrow or peripheral stem cell transplant as first salvage treatment for relapsed or refractory Hodgkin lymphoma

T2 - A single institution experience

AU - Viviani, Simonetta

AU - Di Nicola, Massimo

AU - Bonfante, Valeria

AU - Di Stasi, Antonio

AU - Carlo-Stella, Carmelo

AU - Matteucci, Paola

AU - Magni, Michele

AU - Devizzi, Liliana

AU - Valagussa, Pinuccia

AU - Gianni, Alessandro M.

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AB - The introduction of high-dose (HD) chemotherapy (CT) and autologous stem cell (ASCT) or bone marrow transplant (ABMT) in the last two decades has improved the prognosis of patients with refractory or relapsed Hodgkin lymphoma (HL) over conventional-dose salvage CT. To evaluate the outcome of adult patients with HL treated with HD CT and ASCT or ABMT after failure or relapse from first-line treatment with CT±radiotherapy, we report the results of a retrospective analysis in 82 consecutive patients given HD CT and autologous transplant as second-line therapy between October 1984 and December 2006. Thirty-two patients were given sequential high-dose cytoreductive therapy while 50 received other conventional induction regimens. Seventy-three patients with chemoresponsive disease underwent the myeloablative phase, while eight patients had progressive disease during cytoreductive CT. After a median follow-up of 73 months, the 10-year progression-free survival (PFS) and overall survival (OS) were 57 and 51, respectively. According to response to first-line treatment, PFS and OS were, respectively, 54 and 82 for patients with complete remission (CR) lasting 12 months or more; 49 and 51 for patients with CR less than 12 months; and 47 and 50 for patients who never achieved CR or progressed during first-line CT (induction failure). Response to cytoreductive CT significantly influenced outcome, with PFS and OS being, respectively, 56 and 68 vs. 44 and 47 (p0.009) in patients in CR versus patients not in CR after induction therapy. Treatment was well tolerated, and therapy related mortality was only 3.7. These long-term results confirm that HD CT and ASCT or ABMT was feasible, safe, and very effective. Therefore, this therapeutic strategy may represent an active salvage approach even in the unfavorable group of patients with induction failure.

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