Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin's lymphoma: identification of prognostic factors predicting outcome
Por:
Robinson, SP, Sureda, A, Canals, C, Russell, N, Caballero, D, Bacigalupos, A, Iriondo, A, Cook, G, Pettitt, A, Socie, G, Bonifazi, F, Bosi, A, Michallet, M, Liakopoulou, E, Maertens, J, Passweg, J, Clarke, F, Martin, R, Schmitz, N
Publicada:
1 feb 2009
Resumen:
Background
The role of reduced intensity conditioning allogeneic stem transplantation (RICalloSCT) in the management of patients with Hodgkin's lymphoma remains controversial.
Design and Methods
To further define its role we have conducted a retrospective analysis of 285 patients with HL who underwent a RICalloSCT in order to identify prognostic factors that predict outcome. Eighty percent of patients had undergone a prior autologous stem cell transplantation and 25% had refractory disease at transplant.
Results
Non-relapse mortality was associated with chemorefractory disease, poor performance status, age >45 and transplantation before 2002. For patients with no risk factors the 3-year non-relapse mortality rate was 12.5% compared to 46.2% for patients with 2 or more risk factors. The use of an unrelated donor had no adverse effect on the non-relapse mortality. Acute graft versus host disease (aGVHD) grades II-IV developed in 30% and chronic GVHD in 42%. The development of cGVHD was associated with a lower relapse rate. The disease progression rate at one and five years was 41% and 58.7% respectively and was associated with chemorefractory disease and extent of prior therapy. Donor lymphocyte infusions were administered to 64 patients for active disease of whom 32% showed a clinical response. Eight out of 18 patients receiving donor lymphocyte infusions alone had clinical responses. Progression-free and overall survival were both associated with performance status and disease status at transplant. Patients with neither risk factor had a 3-year PFS and overall survival of 42% and 56% respectively compared to 8% and 25% for patients with one or more risk factors. Relapse within six months of a prior autologous transplant was associated with a higher relapse rate and a lower progression-free.
Conclusions
This analysis identifies important clinical parameters that may be useful in predicting the outcome of RICallCalloSCT in Hodgkin's lymphoma.
Filiaciones:
Robinson, SP:
Bristol Childrens Hosp, BMT Unit, Bristol BS2 8BJ, Avon, England
Sureda, A:
Hosp Santa Creu & Sant Pau, Clin Hematol Div, Barcelona, Spain
Canals, C:
Lymphoma Working Party EBMT, Barcelona, Spain
Russell, N:
City Hosp Nottingham, Dept Hematol, Nottingham, England
Caballero, D:
Hosp Clin Salamanca, Hematol Serv, Salamanca, Spain
Bacigalupos, A:
Osped San Martino Genova, Dept Hematol, Genoa, Italy
Iriondo, A:
Hosp U Marques de Valdecilla, Serv Hematol, Santander, Spain
Cook, G:
St James Univ Hosp, Dept Hematol, Leeds, W Yorkshire, England
Pettitt, A:
Royal Liverpool Univ Hosp, Dept Hematol, Liverpool, Merseyside, England
Socie, G:
Hop St Louis, Dept Hematol, Paris, France
Bonifazi, F:
Univ Bologna, Inst Hematol & Med Oncol, I-40126 Bologna, Italy
Bosi, A:
Osped Careggi, Dept Hematol, Florence, Italy
Michallet, M:
Hop Edouard Herriot, BMT Unit, Lyon, France
Liakopoulou, E:
Christie Hosp, Manchester, Lancs, England
Maertens, J:
Univ Hosp Gasthuisberg, Dept Hematol, B-3000 Louvain, Belgium
Passweg, J:
Hop Univ Geneve, Dept Internal Med, Geneva, Switzerland
Clarke, F:
Univ Birmingham, Dept Hematol, Birmingham B15 2TT, W Midlands, England
Schmitz, N:
Allgemein Krankenhaus St Georg, Dept Hematol, Hamburg, Germany
Gold, Green Published
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