Originally published as JCO Early Release 10.1200/JCO.2007.15.5887 on November 17 2008

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Risk-Adapted Salvage Treatment With Single or Tandem Autologous Stem-Cell Transplantation for First Relapse/Refractory Hodgkin's Lymphoma: Results of the Prospective Multicenter H96 Trial by the GELA/SFGM Study Group

Franck Morschhauser, Pauline Brice, Christophe Fermé, Marine Diviné, Gilles Salles, Reda Bouabdallah, Catherine Sebban, Laurent Voillat, Olivier Casasnovas, Aspasia Stamatoullas, Krimo Bouabdallah, Marc André, Jean-Philippe Jais, Dominique Cazals-Hatem, Christian Gisselbrecht

From the Centre Hospitalier Universitaire (CHU) Lille, Lille; CHU Hôpital Saint-Louis Assistance Publique-Hôpitaux de Paris (AP-HP); Hôpital Necker AP-HP; Hôpital Beaujon AP-HP, Paris; Institut Gustave-Roussy, Villejuif; CHU Henri-Mondor AP-HP, Créteil; CHU Lyon-Sud, Pierre-Bénite; Institut Paoli-Calmette, Marseille; Centre Leon-Berard, Lyon; Centre Hospitalier W. Morey, Chalon-sur-Saône; CHU du Bocage, Dijon; Centre Becquerel, Rouen; CHU Hôpital Haut-Lévêque, Pessac, France; and Centre Hospitalier Notre Dame et Reine Fabiola Charleroi, Charleroi, Belgium

Corresponding author: Franck Morschhauser, MD, Service des Maladies du Sang, Hôpital Huriez, Centre Hospitalier Universitaire Lille, rue Michel Polonovski, 59037 Lille Cedex, France; e-mail: f-morschhauser{at}chru-lille.fr

Purpose A prospective multicenter trial evaluated a risk-adapted salvage treatment with single or tandem autologous stem-cell transplantation (ASCT) for 245 Hodgkin's lymphoma (HL) patients who experience treatment failure with first-line therapy.

Patients and Methods Poor-risk patients (150 with primary refractory disease or two of the following risk factors at first relapse: time to relapse < 12 months, stage III or IV at relapse, and relapse within previously irradiated sites) or intermediate-risk patients (95 with one risk factor at relapse) were eligible for tandem or single ASCT, respectively.

Results Among poor-risk patients, 105 (70%), including 30 of 55 with cytoreductive chemotherapy-resistant disease, received tandem ASCT, whereas 92 intermediate-risk patients (97%) received single ASCT. According to intent-to-treat analysis, the 5-year freedom from second failure and overall survival (OS) estimates were 73% and 85%, respectively, for the intermediate-risk group and 46% and 57%, respectively, for the poor-risk group. Outcomes were similar for primary refractory and poor-risk/relapsed HL. For patients with chemotherapy-resistant disease, the 46% 5-year OS rate achieved with tandem ASCT compares favorably with the previously reported 30%. Outcomes for partial and complete responders to cytoreduction receiving tandem ASCT did not differ significantly and were better than those previously reported for partial responders receiving single ASCT, but not superior to those reported for complete responders receiving single ASCT. Six poor-risk patients (4%) died from toxicity.

Conclusion Single ASCT is appropriate for intermediate-risk patients. For poor-risk patients, our results suggest a benefit of tandem ASCT for half of the patients with chemotherapy-resistant disease and partial responders, but not for complete responders to cytoreductive chemotherapy.

published online ahead of print at www.jco.org on November 17, 2008

Supported by grants from Amgen, Neuilly, France; and Chugai, Suresnes, France.

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

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