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Long-Term Results of Blood and Marrow Transplantation for Hodgkin’s Lymphoma

From the Johns Hopkins Oncology Center, Baltimore, MD.

Address reprint requests to Richard J. Jones, MD, Johns Hopkins Oncology Center, The Bunting and Blaustein Cancer Research Building, Room 207, 1650 Orleans St, Baltimore, MD 21231; email: rjjones{at}jhmi.edu

	ABSTRACT

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

 
PURPOSE: To evaluate the long-term outcome after allogeneic (allo) and autologous (auto) blood or marrow transplantation (BMT) in patients with relapsed or refractory Hodgkin’s lymphoma (HL).

PATIENTS AND METHODS: We analyzed the outcome of 157 consecutive patients with relapsed or refractory HL, who underwent BMT between March 1985 and April 1998. Patients age 55 with HLA-matched siblings were prioritized toward allo BMT. The median age was 28 years (range, 13 to 52 years) for the 53 allo patients and 30.5 years (range, 11 to 62 years) for the 104 auto patients.

RESULTS: The median follow-up after BMT for surviving patients was 5.1 years (range, 1 to 13.8 years). For the entire group, the probabilities of event-free survival (EFS) and relapse at 10 years were 26% (95% confidence interval [CI], 18% to 33%) and 58% (95% CI, 48% to 69%), respectively. According to multivariate analysis, disease status before BMT (sensitive relapse if responding to conventional-dose therapy or resistant disease if not) (hazard ratio [HR] = 0.39, P < .0001) and date of BMT (HR = 0.93, P = .004) were independent predictors of EFS, whereas only disease status (HR = 0.35, P < .0001) influenced relapse. There was a trend for probability of relapse in sensitive patients to be less after allo BMT at 34% (range, 8% to 59%) versus 51% (range, 36% to 67%) for the auto patients (HR = 0.51, P = .17). There was a continuing risk of relapse or secondary acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) for 12 years after auto BMT, whereas there were no cases of secondary AML/MDS or relapses beyond 3 years after allo BMT.

CONCLUSION: There seems to be a clinical graft-versus-HL effect associated with allo BMT. Allo BMT for HL also seems to have a lower risk of secondary AML/MDS than auto BMT. Thus, allo BMT warrants continued study in HL.

	INTRODUCTION

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

 
HIGH-DOSE THERAPY followed by blood or marrow transplantation (BMT) has emerged as the treatment of choice for most patients with relapsed or refractory hematologic malignancies, including Hodgkin’s lymphoma (HL).^1,2 Allogeneic (allo) BMT is generally preferred over autologous (auto) BMT for leukemias, because of the potent graft-versus-leukemia effect associated with allografts and concern regarding leukemic contamination of autografts. However, the role of allo BMT in patients with relapsed or refractory HL has been highly controversial, even though the median age of this disease is less than 30 years. Several series have suggested that allo BMT may be preferred over auto BMT in some patients with HL, because there seems to be a clinically significant graft-versus-HL effect.^3-5 Conversely, there has been a preference in many centers for auto BMT in patients with recurrent HL.^1,2,6-13 Moreover, recent reports from the International Bone Marrow Transplant Registry (IBMTR)¹⁴ and the European Group for Blood and Marrow Transplantation (EBMT)¹⁵ demonstrate disappointing results with allo BMT in HL and suggest that allo BMT should play a limited role in the treatment of this disease.

It is possible that the different conclusions regarding the role of allo BMT in HL could be the result of patient selection. It is clear that a number of factors, especially disease status^5-7,11,16 and number of relapses^1,5,6,10 at the time of BMT, strongly influence the outcome of BMT for HL. At Johns Hopkins, allo BMT has been prioritized over auto BMT for HL based on our previous results, which first reported a graft-versus-lymphoma effect.³ The eligibility criteria and BMT conditioning regimens have been the same for the auto and allo patients. To investigate the impact of allo BMT on HL, especially with long-term follow-up, we analyzed the influence of various factors on the outcome of patients undergoing BMT for HL at our institution.

	PATIENTS AND METHODS

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

 
Patients
Between March 1985 and April 1998, 157 consecutive patients with relapsed or refractory HL underwent BMT at the Johns Hopkins Oncology Center (Baltimore, MD). The first 55 patients were previously reported.^3,16 Patients were eligible for BMT if they were 65 years of age and had progressed during, or relapsed after, standard chemotherapy regimens for HL. Additional eligibility requirements included a Karnofsky performance status of at least 70% and adequate cardiac (ejection fraction 45%), pulmonary (forced vital capacity 70%), hepatic (bilirubin 2 mg/dL), and renal (creatinine 2 mg/dL) function. Patients 55 years of age with an HLA-identical family member were prioritized to allo BMT. Before 1995, patients in first relapse were eligible for BMT only if their remission was less than 12 months. After 1995, all patients in first relapse were eligible for BMT. All patients gave informed consent for study participation as approved by the Joint Committee on Clinical Investigation of the Johns Hopkins Hospital.

Treatment Protocol
Preparative therapy consisted of busulfan (1 mg/kg every 6 hours for 16 doses) followed by cyclophosphamide (50 mg/kg/d x 4 days) in 88 patients (56%), cyclophosphamide followed by total-body irradiation (3 Gy daily x 4 days, with lung shielding on day 2 or 3) in 44 patients (28%), or busulfan, cyclophosphamide (50 mg/kg/d x 3 days), and etoposide (20 to 60 mg/kg) in 25 patients (16%). The total-body irradiation source was ⁶⁰Co at a dose rate of 0.05 to 0.08 Gy/min before 1988 and a 4-MV linear accelerator at .096 Gy/min since 1988. All dosing was based on ideal body weight. The preparative therapy was decided by the institutional protocol active at the time and was the same for both auto and allo patients. Supportive care, including graft-versus-host disease (GVHD) prophylaxis and treatment, was provided as previously described.^16-19 Since 1987, most allografts were T-cell depleted by counterflow centrifugal elutriation, as previously described.^18-20 Patients receiving T-cell–depleted allografts also received cyclosporine as GVHD prophylaxis; most patients receiving unmanipulated allografts also received just cyclosporine as GVHD prophylaxis, although six received cyclosporine and methotrexate. Autografts were harvested and cryopreserved before administering the BMT preparative therapy; autografts harvested before 1996 were treated with 4-hydroperoxycyclophosphamide (4HC), as previously described.²¹ Five patients received autografts obtained by peripheral-blood leukopheresis after mobilization with cyclophosphamide (2.5 g/m² intravenously) and granulocyte colony-stimulating factor (10 mg/kg/d); these were the only patients who received routine posttransplant growth factors (granulocyte colony-stimulating factor).

Study Definitions and Statistical Analysis
Immediately before BMT, relapsed patients’ disease status was prospectively classified according to their response to a median of 2, ranging from 0 to 6, cycles of conventional-dose salvage chemotherapy administered before BMT.^6,7,16 The salvage therapy was administered by the referring physician and was not standardized. Sensitive relapse was defined as (1) showing at least a partial response (> 50% decrease in tumor size by the sum of the products of the perpendicular diameters of all areas of known disease) to conventional salvage therapy immediately before BMT or (2) proceeding directly to BMT without receiving any salvage therapy. Patients were defined as having resistant disease if their HL progressed through their initial combination chemotherapy treatment or if their relapsed disease showed less than a partial response to conventional salvage therapy immediately before BMT.

The major statistical end points of this study were relapse and event-free survival (EFS) after BMT. All patients were included in this analysis. EFS was defined as the time from day of BMT until death from any cause at any time, disease progression, or secondary malignancy. Event-time distributions were estimated using the Kaplan-Meier method.²² For categorical prognostic factors, event time distributions were compared using the log-rank statistic.²³

The significance of continuously distributed prognostic factors was tested using the proportional hazards model.²⁴ The multivariate proportional hazards model was used to adjust for the effect of several prognostic factors simultaneously. For time-to-event distributions, point estimates are given ± 95% confidence intervals as determined from standard life-table methods. ² testing was used to compare proportions. All P values reported are two-sided. The data was analyzed as of October 1, 2000.

	RESULTS

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Demographics
Characteristics of the 157 consecutive patients with relapsed or refractory HL who underwent allo (n = 53) or auto (n = 104) BMT at the Johns Hopkins Oncology Center between March 1985 and April 1998 are listed in Table 1. Ninety patients (57%) had sensitive relapse at the time of transplant; 83 patients had either partial (n = 52) or complete response (n = 31) to a standard salvage chemotherapy, and seven patients were in untreated relapse after initial chemotherapy. The other 67 patients (43%) had resistant disease at the time of BMT; 60 patients were unresponsive to conventional salvage chemotherapy at relapse, and seven patients’ disease progressed through initial chemotherapy. Allo patients were more likely to have resistant disease (P = .06), to have suffered multiple relapses (P = .009), to have marrow involvement (P = .004), and to have B symptoms (P .0001) at the time of BMT compared with auto patients (Table 1). Other patient characteristics, including age, duration of first complete remission, type of preparative regimen, and year of BMT were comparable between the allo and auto patients. Autografts were purged with 4HC in 78 auto patients (75%) transplanted before 1996. Mobilized peripheral blood was the autograft in five patients. In the allo group, 28 (53%) of 53 patients received T-cell–depleted bone marrow.

Survival
Overall, 65 (41%) of 157 patients are still alive, 47 (30%) in a continued complete remission with a median follow-up time for surviving patients of 5.1 years (range, 1 to 13.8 years) after BMT. The probability of relapse for the entire 157 patients at 10 years was 58% (95% confidence interval [CI], 48% to 69%), with the latest disease progression occurring 12 years after BMT. The probabilities of relapse at 10 years after BMT were 53% (95% CI, 34% to 72%) and 60% (95% CI, 48% to 73%) for the allo and auto patients, respectively (hazard ratio [HR] = 0.91, P = .76, Fig 1A]. The probability of EFS at 10 years after BMT was 26% (95% CI, 18% to 33%); the probability of EFS was the same for the allo and auto patients (HR = 1.32, P = .16, Fig 1B). The probabilities of overall survival were 30% (95% CI, 18% to 44%) and 37% (95% CI, 25% to 48%) for allo and auto patients, respectively (HR = 1.6, P = .2, Fig 1C).

View larger version (14K): [in this window] [in a new window]   Fig 1. Probabilities of (A) relapse (53% [95% CI, 34% to 72%] and 60% [95% CI, 48% to 73%], P = .76), (B) EFS (27% [95% CI, 21% to 34%] and 26% [95% CI, 21% to 31%] at 10 years, P = .16), and (C) overall survival (30% [95% CI, 18% to 41%] and 37% [95% CI, 25% to 48%], P = .2) after allo (dashed line) or auto (solid line) BMT, respectively, for HL.

View larger version (14K): [in this window] [in a new window]   Fig 2. The probabilities of (A) relapse (34% [95% CI, 8% to 59%] and 51% [95% CI, 36% to 67%], P = .17), (B) EFS (44% [95% CI, 23% to 65%] and 33% [95% CI, 20% to 46%] at 10 years, P = .54), and (C) overall survival (63% [95% CI, 41% to 79%] and 44% [95% CI, 29% to 58%], P = .83) after allo (dashed line) or auto (solid line) BMT, respectively, in sensitive relapse.

View larger version (21K): [in this window] [in a new window]   Fig 3. The probabilities of relapse in the 11 patients in sensitive relapse who developed GVHD (14%; 95% CI, 0% to 40%) (dashed line) and the 14 who did not develop GVHD (55%; 95% CI, 13% to 96%) (solid line) after allo BMT (P = .24).

	DISCUSSION

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

There was a trend for allo BMT to be associated with a lower risk of relapse in the sensitive relapse patients. Although the lower risk of relapse after allo BMT in sensitive relapse patients did not reach statistical significance (P = .17), there was a two-fold lower risk after allo BMT by HR. This suggests that the lack of statistical significance may result from the relatively small sizes of the groups. The trend toward a lower risk of relapse after allo BMT in sensitive relapse, especially in those patients developing GVHD, suggests that allo BMT produces a clinical graft-versus-HL effect. A number of strategies that could potentially augment the graft-versus-HL effect, such as mobilized peripheral blood grafts or nonmyeloablative conditioning regimens with donor lymphocyte infusions, might improve the results of allo BMT for HL. However, these approaches may substantially increase the GVHD-related toxicity associated with allo BMT. Moreover, it is possible that nonmyeloablative conditioning regimens may decrease the efficacy of allo BMT in HL because the excellent results with auto BMT demonstrate the activity of high-dose conditioning regimens in this disease.

Although the EFS after allo and auto BMT in patients in sensitive relapse is similar at 4 years, the long-term EFS may favor allo BMT. Multiple reports now confirm that the incidence of secondary AML/MDS after auto BMT for HL ranges from 5% to 25%,^12,25,26 whereas it is rare after allo BMT. There were no cases of secondary AML/MDS, or relapses beyond 3 years, after allo BMT; whereas there was a continuing risk of relapse and secondary AML/MDS for 12 years after auto BMT. In fact, nearly 20% of the failures (relapse or secondary AML/MDS) after auto BMT occurred beyond 3 years after BMT. Review of data from the Autologous Blood and Marrow Transplant Registry²⁷ and the Spanish Cooperative Group¹² also shows a substantial number of late failures after auto BMT for HL.

Most of our auto BMT patients received 4HC-purged grafts and, thus, experienced delayed hematopoietic recovery, which might have a negative impact on overall survival. However, the transplant-related mortality was only 7% (three of 41 patients), with only one infectious death, in the patients undergoing auto BMT at first sensitive relapse. The higher transplant-related mortality (23%) in the patients undergoing auto BMT in resistant disease is similar to that seen in other studies that did not use marrow purging.^12,13,15 Relapse was the cause of failure in the vast majority of auto patients.

Recent reports from the IBMTR¹⁴ and the EBMT¹⁵ demonstrated disappointing results with allo BMT in HL and suggested that allo BMT should play a limited role in the treatment of HL. Although the details concerning the status of the patients in these reports was somewhat limited, it is clear that most of the patients in both of these reports had advanced, poor-risk disease. Half of the patients in the IBMTR series had a performance status at BMT of 80%, and more than 60% had evidence of active stage IV disease at the time of BMT.¹⁴ The majority of patients in the EBMT series had resistant disease (primary refractory or resistant relapse) and B symptoms at the time of BMT;¹⁵ the poor-risk status of these patients is further confirmed by the fact that long-term EFS was less than 20% in both the allo and auto patients in this series.¹⁵ We also found that allo BMT produced no detectable benefit over auto BMT in our HL patients with resistant disease. As in our series, the poor outcome in resistant patients in the registries was the result of both a high transplant-related mortality and a high relapse rate; the transplant-related mortality was greater than 30% and the relapse rate was greater than 60% in both series.^14,15 Any advantage of allo BMT in the treatment of HL patients with resistant disease seems to be offset by the unfavorable features of these patients.

Allo BMT seems to produce a clinical graft-versus-HL effect that is associated with a lower risk of late relapse than auto BMT. Allo BMT for HL also seems to have a lower risk of secondary AML/MDS than auto BMT. The poor outcomes reported by the IBMTR¹⁴ and EBMT¹⁵ for allo BMT in HL probably results from the selection of unfavorable-risk patients. We believe that allo BMT warrants continued study in HL.

	ACKNOWLEDGMENTS

 
Supported in part by National Institutes of Health grant no. P01 CA15396.

	NOTES

 
Presented in the Oral Session at the Thirty-Fifth Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, May 15-18, 1999.

	REFERENCES

TOP ABSTRACT INTRODUCTION PATIENTS AND METHODS RESULTS DISCUSSION REFERENCES

 
1. Armitage JO, Bierman PJ, Vose JM, et al: Autologous bone marrow transplantation for patients with relapsed Hodgkin’s disease. Am J Med 91: 605-611, 1991[Medline]

2. Yuen AR, Rosenberg SA, Hoppe RT, et al: Comparison between conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory Hodgkin’s disease. Blood 89: 814-822, 1997[Abstract/Free Full Text]

3. Jones RJ, Ambinder RF, Piantadosi S, et al: Evidence of a graft-versus-lymphoma effect associated with allogeneic bone marrow transplantation. Blood 77: 649-653, 1991[Abstract/Free Full Text]

4. Phillips GL, Reece DE, Barnett MJ, et al: Allogeneic marrow transplantation for refractory Hodgkin’s disease. J Clin Oncol 7: 1039-1045, 1989[Abstract]

5. Anderson JE, Litzow MR, Appelbaum FR, et al: Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin’s disease: The 21-year Seattle experience. J Clin Oncol 11: 2342-2350, 1993[Abstract/Free Full Text]

6. Jagannath S, Armitage JO, Dicke KA, et al: Prognostic factors for response and survival after high-dose cyclophosphamide, carmustine, and etoposide with autologous bone marrow transplantation for relapsed Hodgkin’s disease. J Clin Oncol 7: 179-185, 1989[Abstract]

7. Carella AM, Congiu AM, Gaozza E, et al: High-dose chemotherapy with autologous bone marrow transplantation in 50 advanced resistant Hodgkin’s disease patients: An Italian study group report. J Clin Oncol 6: 1411-1416, 1988[Abstract/Free Full Text]

8. Ahmed T, Ciavarella D, Feldman E, et al: High-dose, potentially myeloablative chemotherapy and autologous bone marrow transplantation for patients with advanced Hodgkin’s disease. Leukemia 3: 19-22, 1989[Medline]

9. Reece DE, Connors JM, Spinelli JJ, et al: Intensive therapy with cyclophosphamide, carmustine, etoposide +/- cisplatin, and autologous bone marrow transplantation for Hodgkin’s disease in first relapse after combination chemotherapy. Blood 83: 1193-1199, 1994[Abstract/Free Full Text]

10. Nademanee A, O’Donnell MR, Snyder DS, et al: High-dose chemotherapy with or without total body irradiation followed by autologous bone marrow and/or peripheral blood stem cell transplantation for patients with relapsed and refractory Hodgkin’s disease: Results in 85 patients with analysis of prognostic factors. Blood 85: 1381-1390, 1995[Abstract/Free Full Text]

11. Horning SJ, Chao NJ, Negrin RS, et al: High-dose therapy and autologous hematopoietic progenitor cell transplantation for recurrent or refractory Hodgkin’s disease: Analysis of the Stanford University results and prognostic indices. Blood 89: 801-813, 1997[Abstract/Free Full Text]

12. Sureda A, Arranz R, Iriondo A, et al: Autologous stem-cell transplantation for Hodgkin’s disease: results and prognostic factors in 494 patients from the Grupo Espanol de Linfomas/Transplante Autologo de Medula Osea Spanish Cooperative Group. J Clin Oncol 19: 1395-1404, 2001[Abstract/Free Full Text]

13. Lazarus HM, Rowlings PA, Zhang MJ, et al: Autotransplants for Hodgkin’s disease in patients never achieving remission: A report from the Autologous Blood and Marrow Transplant Registry. J Clin Oncol 17: 534-545, 1999[Abstract/Free Full Text]

14. Gajewski JL, Phillips GL, Sobocinski KA, et al: Bone marrow transplants from HLA-identical siblings in advanced Hodgkin’s disease. J Clin Oncol 14: 572-578, 1996[Abstract/Free Full Text]

15. Milpied N, Fielding AK, Pearce RM, et al: Allogeneic bone marrow transplant is not better than autologous transplant for patients with relapsed Hodgkin’s disease: European Group for Blood and Bone Marrow Transplantation. J Clin Oncol 14: 1291-1296, 1996[Abstract/Free Full Text]

16. Jones RJ, Piantadosi S, Mann RB, et al: High-dose cytotoxic therapy and bone marrow transplantation for relapsed Hodgkin’s disease. J Clin Oncol 8: 527-537, 1990[Abstract]

17. Santos GW, Tutschka PJ, Brookmeyer R, et al: Cyclosporine plus methylprednisolone versus cyclophosphamide plus methylprednisolone as prophylaxis for graft-versus-host disease: A randomized double-blind study in patients undergoing allogeneic marrow transplantation. Clin Transplant 1: 21-28, 1987

18. Wagner JE, Donnenberg AD, Noga SJ, et al: Lymphocyte depletion of donor bone marrow by counterflow centrifugal elutriation: Results of a phase I clinical trial. Blood 72: 1168-1176, 1988[Abstract/Free Full Text]

19. Wagner JE, Santos GW, Noga SJ, et al: Bone marrow graft engineering by counterflow centrifugal elutriation: Results of a phase I-II clinical trial. Blood 75: 1370-1377, 1990[Abstract/Free Full Text]

20. Noga SJ, Seber A, Davis JM, et al: CD34 augmentation improves allogeneic T cell-depleted bone marrow engraftment. J Hematother 7: 151-157, 1998[Medline]

21. Yeager AM, Kaizer H, Santos GW, et al: Autologous bone marrow transplantation in patients with acute nonlymphocytic leukemia, using ex vivo marrow treatment with 4-hydroperoxycyclophosphamide. N Engl J Med 315: 141-147, 1986[Abstract]

22. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457-481, 1958

23. Mantel N, Haenzel W: Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22: 719-748, 1959

24. Cox DR: Regression models and life tables. J R Stat Soc 34: 187-220, 1972

25. Miller JS, Arthur DC, Litz CE, et al: Myelodysplastic syndrome after autologous bone marrow transplantation: An additional late complication of curative cancer therapy. Blood 83: 3780-3786, 1994[Abstract/Free Full Text]

26. Pedersen-Bjergaard J, Andersen MK, Christiansen DH: Therapy-related acute myeloid leukemia and myelodysplasia after high- dose chemotherapy and autologous stem cell transplantation. Blood 95: 3273-3279, 2000[Abstract/Free Full Text]

27. Rizzo JD: Summary slides 2000. IBMTR/ABMTR Newsletter 7: 3-10, 2000

Submitted November 30, 2000; accepted June 27, 2001.

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