Originally published as JCO Early Release 10.1200/JCO.2007.13.2415 on December 17 2007

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Reduced-Intensity Conditioning Compared With Conventional Allogeneic Stem-Cell Transplantation in Relapsed or Refractory Hodgkin's Lymphoma: An Analysis From the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation

Anna Sureda, Stephen Robinson, Carmen Canals, Angelo M. Carella, Marc A. Boogaerts, Dolores Caballero, Ann E. Hunter, Lothar Kanz, Shimon Slavin, Jan J. Cornelissen, Martin Gramatzki, Dietger Niederwieser, Nigel H. Russell, Norbert Schmitz

From the Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona; Departmento de Hematologia, Hospital Clinico Universitario, Salamanca, Spain; Department of Paediatric Oncology/Bone Marrow Transplantation, Bristol Royal Hospital for Children, Bristol; Department of Haematology, Leicester Royal Infirmary, Leicester; Nottingham City Hospital, Nottingham, United Kingdom; Azienda Ospedaliera Universitaria San Martino, Genoa, Italy; Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium; Medizinische Klinik, Universität Tübingen; Division of Stem Cell Transplantation and Immunotherapy, 2nd Medical Department, University Hospital Schleswig-Holstein Keil Campus, Kiel; Division of Hematology and Oncology, University Hospital Leipzig, Leipzig; Department of Haematology, Asklepios Klinik St Georg, Hamburg, Germany; Blood and Bone Marrow Tansplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and Erasmus MC-Daniel den Hoed Cancer Center, Rottendam, the Netherlands

Corresponding author: Anna Sureda, MD, Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Antoni Maria i Claret, 167, 08025 Barcelona, Spain; e-mail: asureda{at}santpau.es

Purpose: To compare the clinical outcome in terms of nonrelapse mortality (NRM), relapse rate (RR), overall survival (OS), and progression-free survival (PFS) in patients with relapsed Hodgkin's lymphoma (HL) treated with reduced-intensity conditioning (RIC) or myeloablative conditioning followed by allogeneic stem-cell transplantation (alloSCT).

Patients and Methods: A total of 168 patients with HL undergoing a first alloSCT (RIC, n = 89; myeloablative conditioning, n = 79) between January 1997 and December 2001 and registered in the European Group for Blood and Marrow Transplantation database were analyzed.

Results: NRM was significantly decreased in the RIC group (hazard ratio [HR], 2.85; 95% CI, 1.62 to 5.02; P < .001). OS was better in the RIC group (HR, 2.05; 95% CI, 1.27 to 3.29; P = .04) and there was a trend for better PFS in the RIC group (HR, 1.53; 95% CI, 0.97 to 2.40; P = .07). RR was higher in the RIC group in univariate but not in multivariate analysis. The development of chronic graft-versus-host disease (GVHD) significantly decreased the incidence of relapse, which translated into a trend for a better PFS.

Conclusion: The lower incidence of NRM in the RIC group is encouraging, particularly because these patients experienced adverse pretransplantation characteristics more frequently. This analysis also indicates the existence of a graft-versus-HL effect correlated to the development of GVHD. Additional efforts to reduce the high RR seen in both groups of patients will be necessary to improve the modest PFS (31% v 27%) and OS (59% v 36%) for patients prepared with RIC or myeloablative conditioning.

published online ahead of print at www.jco.org on December 17, 2007.

Presented in part at the 45th Annual Meeting of the American Society of Hematology, December 6-9, 2003, San Diego, CA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.