This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lazarus, B. H. M. Articles by Horowitz, M. M. Search for Related Content PubMed PubMed Citation Articles by Lazarus, B. H. M. Articles by Horowitz, M. M. Social Bookmarking                            What's this?

Autotransplants for Hodgkin's Disease in Patients Never Achieving Remission: A Report From the Autologous Blood and Marrow Transplant Registry

Address reprint requests to Hillard M. Lazarus, MD, Department of Medicine, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106; email hml{at}po.cwru.edu

PURPOSE: Hodgkin's disease patients who never achieve complete remission with conventional chemotherapy (ie, those with primary induction failure) have a poor prognosis. Some subjects who receive high-dose therapy with autologous hematopoietic progenitor-cell infusion experience prolonged progression-free survival.

PATIENTS AND METHODS: Detailed records from the Autologous Blood and Marrow Transplant Registry (ABMTR) on 122 Hodgkin's disease patients who failed to achieve complete remission after one or more conventional therapy regimens and subsequently received an autotransplant between 1989 and 1995 were reviewed.

RESULTS: Median age was 27 years (range, 7 to 57 years). Median time from diagnosis to transplantation was 14 months (range, 5 to 38 months). Most patients received high-dose chemotherapy without radiation for pretransplantation conditioning (n = 107). The regimen most frequently used was cyclophosphamide, carmustine, and etoposide (n = 47). Fifteen patients received total-body irradiation (n = 15). The graft consisted ofbone marrow (n = 86), blood stem cells (n = 25), or both (n = 11). The 100-day mortality was 12% (95% confidence interval, 7% to 19%). Sixty patients (50%) were considered to have achieved complete remission after autotransplantation; 37 of these had negative imaging studies, whereas scan abnormalities of unknown significance persisted in 23 patients. Twenty-seven patients (22%) had no response or progressive disease after transplantation. Probabilities of progression-free and overall survival at 3 years were 38% (95% confidence interval, 28% to 48%) and 50% (95% confidence interval, 39% to 60%), respectively. In multivariate analysis, "B" symptoms at diagnosis and poor performance score at transplantation were adverse prognostic factors for outcome.

CONCLUSION: Autotransplants should be considered for patients with Hodgkin's disease who do not achieve complete remission with conventional therapy.

From the Lymphoma Working Committee of the Autologous Blood and Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI; Department of Medicine, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Department of Medicine, M.D. Anderson Cancer Center, Houston, TX; Division of Bone Marrow and Stem Cell Transplantation, Salick Health Care, Inc., Los Angeles, CA; Toronto Hospital and Ontario Cancer Institute, Toronto, Ontario, Canada; Johns Hopkins Oncology Center, Baltimore, MD; Markey Cancer Center, University of Kentucky, Lexington, KY; and Section of Hematology/Oncology, University of Illinois, Chicago, IL.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				E. Brusamolino, A. Bacigalupo, G. Barosi, G. Biti, P. G. Gobbi, A. Levis, M. Marchetti, A. Santoro, P. L. Zinzani, and S. Tura Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up Haematologica, April 1, 2009; 94(4): 550 - 565. [Abstract] [Full Text] [PDF]

				J. Kuruvilla Standard therapy of advanced Hodgkin lymphoma Hematology, January 1, 2009; 2009(1): 497 - 506. [Abstract] [Full Text] [PDF]

				N. Schmitz, P. Dreger, B. Glass, and A. Sureda Allogeneic transplantation in lymphoma: current status Haematologica, November 1, 2007; 92(11): 1533 - 1548. [Abstract] [Full Text] [PDF]

				A. Evens, J. Altman, B. Mittal, N Hou, A Rademaker, D Patton, L Kaminer, S Williams, S Duffey, D Variakojis, et al. Phase I/II trial of total lymphoid irradiation and high-dose chemotherapy with autologous stem-cell transplantation for relapsed and refractory Hodgkin's lymphoma Ann. Onc., April 1, 2007; 18(4): 679 - 688. [Abstract] [Full Text] [PDF]

				E. Brusamolino and A. M. Carella Treatment of refractory and relapsed Hodgkin's lymphoma: facts and perspectives Haematologica, January 1, 2007; 92(1): 6 - 10. [Full Text] [PDF]

				A. Santoro, M. Magagnoli, M. Spina, G. Pinotti, L. Siracusano, M. Michieli, A. Nozza, B. Sarina, E. Morenghi, L. Castagna, et al. Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin's lymphoma Haematologica, January 1, 2007; 92(1): 35 - 41. [Abstract] [Full Text] [PDF]

				S. M. Ansell and J. O. Armitage Management of Hodgkin Lymphoma Mayo Clin. Proc., March 1, 2006; 81(3): 419 - 426. [Abstract] [Full Text] [PDF]

				J. C. Lavoie, J. M. Connors, G. L. Phillips, D. E. Reece, M. J. Barnett, D. L. Forrest, R. D. Gascoyne, D. E. Hogge, S. H. Nantel, J. D. Shepherd, et al. High-dose chemotherapy and autologous stem cell transplantation for primary refractory or relapsed Hodgkin lymphoma: long-term outcome in the first 100 patients treated in Vancouver Blood, August 15, 2005; 106(4): 1473 - 1478. [Abstract] [Full Text] [PDF]

				A. Josting, C. Rudolph, M. Mapara, J.-P. Glossmann, M. Sienawski, M. Sieber, H. H. Kirchner, B. Dorken, D. K. Hossfeld, J. Kisro, et al. Cologne high-dose sequential chemotherapy in relapsed and refractory Hodgkin lymphoma: results of a large multicenter study of the German Hodgkin Lymphoma Study Group (GHSG) Ann. Onc., January 1, 2005; 16(1): 116 - 123. [Abstract] [Full Text] [PDF]

				J. Czyz, R. Dziadziuszko, W. Knopinska-Postuszuy, A. Hellmann, L. Kachel, J. Holowiecki, J. Gozdzik, J. Hansz, A. Avigdor, A. Nagler, et al. Outcome and prognostic factors in advanced Hodgkin's disease treated with high-dose chemotherapy and autologous stem cell transplantation: a study of 341 patients Ann. Onc., August 1, 2004; 15(8): 1222 - 1230. [Abstract] [Full Text] [PDF]

				T. Baetz, A. Belch, S. Couban, K. Imrie, J. Yau, R. Myers, K. Ding, N. Paul, L. Shepherd, J. Iglesias, et al. Gemcitabine, dexamethasone and cisplatin is an active and non-toxic chemotherapy regimen in relapsed or refractory Hodgkin's disease: a phase II study by the National Cancer Institute of Canada Clinical Trials Group Ann. Onc., December 1, 2003; 14(12): 1762 - 1767. [Abstract] [Full Text] [PDF]

				M. Constans, A. Sureda, M. J. Terol, R. Arranz, M. D. Caballero, A. Iriondo, I. Jarque, E. Carreras, J. M. Moraleda, D. Carrera, et al. Autologous stem cell transplantation for primary refractory Hodgkin's disease: results and clinical variables affecting outcome Ann. Onc., May 1, 2003; 14(5): 745 - 751. [Abstract] [Full Text] [PDF]

				V. Diehl, H. Stein, M. Hummel, R. Zollinger, and J. M. Connors Hodgkin's Lymphoma: Biology and Treatment Strategies for Primary, Refractory, and Relapsed Disease Hematology, January 1, 2003; 2003(1): 225 - 247. [Abstract] [Full Text] [PDF]

				P. J. Bierman, J. C. Lynch, R. G. Bociek, V. L. Whalen, A. Kessinger, J. M. Vose, and J. O. Armitage The International Prognostic Factors Project score for advanced Hodgkin's disease is useful for predicting outcome of autologous hematopoietic stem cell transplantation Ann. Onc., September 1, 2002; 13(9): 1370 - 1377. [Abstract] [Full Text] [PDF]

				G. Akpek, R. F. Ambinder, S. Piantadosi, R. A. Abrams, R. A. Brodsky, G. B. Vogelsang, M. L. Zahurak, D. Fuller, C. B. Miller, S. J. Noga, et al. Long-Term Results of Blood and Marrow Transplantation for Hodgkin's Lymphoma J. Clin. Oncol., December 1, 2001; 19(23): 4314 - 4321. [Abstract] [Full Text]

				A. Josting, U. Rueffer, J. Franklin, M. Sieber, V. Diehl, and A. Engert Prognostic factors and treatment outcome in primary progressive Hodgkin lymphoma: a report from the German Hodgkin Lymphoma Study Group Blood, August 15, 2000; 96(4): 1280 - 1286. [Abstract] [Full Text] [PDF]

				R. D. Baynes, C. Hamm, R. Dansey, J. Klein, L. Cassells, C. Karanes, E. Abella, and W. P. Peters Bone Marrow and Peripheral Blood Hematopoietic Stem Cell Transplantation: Focus on Autografting Clin. Chem., August 1, 2000; 46(8): 1239 - 1251. [Abstract] [Full Text] [PDF]

				A. Josting, M. Reiser, U. Rueffer, B. Salzberger, V. Diehl, and A. Engert Treatment of Primary Progressive Hodgkin’s and Aggressive Non-Hodgkin’s Lymphoma: Is There a Chance for Cure? J. Clin. Oncol., January 14, 2000; 18(2): 332 - 332. [Abstract] [Full Text] [PDF]

				J. W. Sweetenham, A. M. Carella, G. Taghipour, D. Cunningham, R. Marcus, A. D. Volpe, D. C. Linch, N. Schmitz, and A. H. Goldstone High-Dose Therapy and Autologous Stem-Cell Transplantation for Adult Patients With Hodgkin's Disease Who Do Not Enter Remission After Induction Chemotherapy: Results in 175 Patients Reported to the European Group for Blood and Marrow Transplantation J. Clin. Oncol., October 1, 1999; 17(10): 3101 - 3109. [Abstract] [Full Text] [PDF]