Survival analysis of patients with Hodgkin lymphoma who failed high dose chemotherapy and autologous stem cell transplant

Survival analysis of patients with Hodgkin lymphoma who failed high dose chemotherapy and... Hodgkin lymphoma (HL) patients failing after high dose chemotherapy (HDC) and auto-SCT have a poor outcome. Some patients may still benefit from further treatments. From 1996 to 2016, 137 HL patients (39.5%) out of 347 transplanted experienced post auto-SCT failure. Males/female 61%:39%, median age at auto-SCT 23.4 years and median follow-up 55.6 months (9–153). Type of failure was progressive (46%), relapsed (35%) or persistent disease/refractory disease (19%). Median overall survival (OS) from the time of failure is 20 months; 35 patients (25.5%) are alive. One hundred and four patients received treatment; the response rate was 45%; complete remission in 41 (30%) and partial remission in 21 (15%) patients. 1st interventions post auto-SCT were chemotherapy (39%), radiation therapy (35%) or best supportive care (24%). Twenty-seven patients with 2nd-SCT (allogeneic (15), auto-SCT (2)) and/or brentuximab (18 patients) had superior OS (50.6 months) vs other treatments (22.5 months, P value 0.037). COX regression multivariate analysis identified post auto-SCT treatment failure before 12 months (hazard ratio (HR) 3.37, CI 1.7–6.6, P value < 0.001), presence of B symptoms (HR 2.55, CI 1.4–4.6, P value 0.002), stages III–IV (HR 2.7, CI 1.5–4.9, P value 0.001), albumin < 4 g/dl (HR 1.76, CI 1.1–2.9, P value 0.027) and tumor > 5 cm (HR 1.1.9, CI 1.13–3.25, P value 0.015) as significant risk factors; P value < 0.001. KM OS with 0–1 factor (148.6 months): 2 factors (23.6 months) and 3–5 factors (9.4 months) (P value < 0.001). OS was 63%:25%:7% respectively with 0–1:2:3–5 factors respectively (P value < 0.001). Despite high-risk factors, 2nd-SCT/brentuximab use post HDC auto-SCT failure may result in durable survival. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Hematology Springer Journals

Survival analysis of patients with Hodgkin lymphoma who failed high dose chemotherapy and autologous stem cell transplant

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Publisher
Springer Journals
Copyright
Copyright © 2018 by Springer-Verlag GmbH Germany, part of Springer Nature
Subject
Medicine & Public Health; Hematology; Oncology
ISSN
0939-5555
eISSN
1432-0584
D.O.I.
10.1007/s00277-018-3283-z
Publisher site
See Article on Publisher Site

Abstract

Hodgkin lymphoma (HL) patients failing after high dose chemotherapy (HDC) and auto-SCT have a poor outcome. Some patients may still benefit from further treatments. From 1996 to 2016, 137 HL patients (39.5%) out of 347 transplanted experienced post auto-SCT failure. Males/female 61%:39%, median age at auto-SCT 23.4 years and median follow-up 55.6 months (9–153). Type of failure was progressive (46%), relapsed (35%) or persistent disease/refractory disease (19%). Median overall survival (OS) from the time of failure is 20 months; 35 patients (25.5%) are alive. One hundred and four patients received treatment; the response rate was 45%; complete remission in 41 (30%) and partial remission in 21 (15%) patients. 1st interventions post auto-SCT were chemotherapy (39%), radiation therapy (35%) or best supportive care (24%). Twenty-seven patients with 2nd-SCT (allogeneic (15), auto-SCT (2)) and/or brentuximab (18 patients) had superior OS (50.6 months) vs other treatments (22.5 months, P value 0.037). COX regression multivariate analysis identified post auto-SCT treatment failure before 12 months (hazard ratio (HR) 3.37, CI 1.7–6.6, P value < 0.001), presence of B symptoms (HR 2.55, CI 1.4–4.6, P value 0.002), stages III–IV (HR 2.7, CI 1.5–4.9, P value 0.001), albumin < 4 g/dl (HR 1.76, CI 1.1–2.9, P value 0.027) and tumor > 5 cm (HR 1.1.9, CI 1.13–3.25, P value 0.015) as significant risk factors; P value < 0.001. KM OS with 0–1 factor (148.6 months): 2 factors (23.6 months) and 3–5 factors (9.4 months) (P value < 0.001). OS was 63%:25%:7% respectively with 0–1:2:3–5 factors respectively (P value < 0.001). Despite high-risk factors, 2nd-SCT/brentuximab use post HDC auto-SCT failure may result in durable survival.

Journal

Annals of HematologySpringer Journals

Published: Feb 26, 2018

References

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