Autologous stem-cell transplantation for Hodgkin's disease: results and prognostic factors in 494 patients from the Grupo Español de Linfomas/Transplante Autólogo de Médula Osea Spanish Cooperative Group.

Abstract

PURPOSE:

To analyze clinical outcome and significant prognostic factors for overall (OS) and time to treatment failure (TTF) in a group of 494 patients with Hodgkin's disease (HD) undergoing autologous stem-cell transplantation (ASCT).

PATIENTS AND METHODS:

Detailed records from the Grupo Español de Linfomas/Transplante Autólogo de Médula Osea Spanish Cooperative Group Database on 494 HD patients who received an ASCT between January 1984 and May 1998 were reviewed. Two hundred ninety-eight males and 196 females with a median age of 27 years (range, 1 to 63 years) received autografts while in complete remission (n = 203) or when they had sensitive disease (n = 206) or resistant disease (n = 75) at a median time of 26 months (range, 4 to 259 months) after diagnosis. Most patients received high-dose chemotherapy without radiation for conditioning (n = 443). The graft consisted of bone marrow (n = 244) or peripheral blood (n = 250).

RESULTS:

The 100-day mortality rate was 9%. The 5-year actuarial TTF and OS rates were 45.0% (95% confidence interval [CI], 39.5% to 50.5%) and 54.5% (95% CI, 48.4% to 60.6%), respectively. In multivariate analysis, the presence of active disease at transplantation, transplantation before 1992, and two or more lines of therapy before transplantation were adverse prognostic factors for outcome. Sixteen patients developed a secondary malignancy (5-year cumulative incidence of 4.3%) after transplantation. Adjuvant radiotherapy before transplantation, the use of total-body irradiation (TBI) in the conditioning regimen, and age > or = 40 years were found to be predictive factors for the development of second cancers after ASCT.

CONCLUSION:

ASCT achieves long-term disease-free survival in HD patients. Disease status before ASCT is the most important prognostic factor for final outcome; thus, transplantation should be considered in early stages of the disease. TBI must be avoided in the conditioning regimen because of a significantly higher rate of late complications, including secondary malignancies.

• Authors: A Sureda, R Arranz, A Iriondo, E Carreras, J J Lahuerta, J García-Conde, I Jarque, M D Caballero, C Ferrà, A López, J García-Laraña, R Cabrera, D Carrera, M D Ruiz-Romero, A León, J Rifón, J Díaz-Mediavilla, R Mataix, M Morey, J M Moraleda, A Altés, A López-Guillermo, J de la Serna, J M Fernández-Rañada, J Sierra, E Conde, Grupo Español de Linformas/Transplante Autólogo de Médula Osea Spanish Cooperative Group
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 19 Issue 5 Pg. 1395-404 (Mar 01 2001) ISSN: 0732-183X [Print] United States
• PMID: 11230484 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Disease Progression
• Female
• Hematopoietic Stem Cell Transplantation
• Hodgkin Disease (pathology, therapy)
• Humans
• Infant
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Survival Analysis
• Transplantation, Autologous
• Treatment Outcome