Journal of Clinical Oncology, Vol 11, 2342-2350, Copyright © 1993 by American Society of Clinical Oncology
Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease: the 21-year Seattle experience
JE Anderson, MR Litzow, FR Appelbaum, G Schoch, LD Fisher, CD Buckner, FB Petersen, SW Crawford, OW Press and JE Sanders
Fred Hutchinson Cancer Research Center, Seattle, WA.
PURPOSE: To analyze results of 127 patients undergoing myeloablative
therapy followed by marrow transplantation for relapsed or refractory
Hodgkin's disease. PATIENTS AND METHODS: Twenty-three patients had primary
refractory disease, 34 were in early first relapse or second complete
remission (CR), and 70 had refractory first relapse or disease beyond
second CR. Preparative regimens included total-body irradiation (TBI) and
chemotherapy (n = 61) or chemotherapy only (n = 66). Sixty- eight patients
received autologous marrow, six syngeneic marrow, and 53 allogeneic marrow.
RESULTS: The 5-year actuarial probabilities of survival, event-free
survival (EFS), relapse, and nonrelapse mortality for the entire group were
21%, 18%, 65%, and 49%, respectively. HLA- identical allogeneic marrow
recipients had a statistically lower relapse rate compared with recipients
of autologous marrow, but survival, EFS, and nonrelapse mortality rates
were not significantly different. In the multivariate analysis, higher
performance status and absence of bulky disease predicted for improved EFS
and lower relapse rates, while fewer prior treatment regimens predicted for
improved EFS and lower nonrelapse mortality rates. Additionally, the
univariate analysis showed that patients who underwent transplantation with
disease refractory to chemotherapy or beyond second CR had a worse outcome
compared with those who had less advanced disease. CONCLUSION: Outcome with
transplantation for patients with Hodgkin's disease is improved if
transplantation is performed early after relapse when disease burden is
less, tumor chemosensitivity is greater, and the patient is likely to have
a better performance status. The use of HLA- matched sibling marrow results
in a lower relapse rate and, thus, for some individuals, may be preferable
to the use of autologous marrow.
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