TY - JOUR
T1 - Autologous Stem Cell Transplantation for Refractory or Poor-Risk Relapsed Hodgkin's Lymphoma
T2 - Effect of the Specific High-Dose Chemotherapy Regimen on Outcome
AU - Nieto, Yago
AU - Popat, Uday
AU - Anderlini, Paolo
AU - Valdez, Ben
AU - Andersson, Borje
AU - Liu, Ping
AU - Hosing, Chitra
AU - Shpall, Elizabeth J.
AU - Alousi, Amin
AU - Kebriaei, Partow
AU - Qazilbash, Muzaffar
AU - Parmar, Simrit
AU - Bashir, Qaiser
AU - Shah, Nina
AU - Khouri, Issa
AU - Rondon, Gabriela
AU - Champlin, Richard
AU - Jones, Roy B.
N1 - Funding Information:
Financial disclosure: Y.N. received research funding from Otsuka Pharmaceuticals . B.A. reports a consultancy with Otsuka Pharmaceuticals and research funding from Otsuka Pharmaceuticals. M.Q. received research funding from Otsuka Pharmaceuticals.
PY - 2013/3
Y1 - 2013/3
N2 - More active high-dose chemotherapy (HDC) regimens are needed for refractory Hodgkin's lymphoma (HL). We report a cohort analysis of 180 consecutive patients with primary refractory or poor-risk relapsed HL treated with busulfan-melphalan (Bu-Mel) (n = 39), gemcitabine-busulfan-melphalan (Gem-Bu-Mel) (n = 84), or BEAM (BCNU, etoposide, ara-C, melphalan; n = 57) between 2005 and 2010. Their pre-HDC positron emission tomography (PET) scans were interpreted prospectively. Despite more prevalent poor-risk features in the Gem-Bu-Mel cohort, such as PET-positive tumors at HDC, tumors growing at HDC, extranodal disease, or bulky tumors at prior relapse, this cohort had improved outcomes compared with the Bu-Mel and BEAM cohorts, with event-free survival (EFS) rates of 57%, 33%, and 39%, respectively (P = .01), at median follow-up of the whole population of 36 months (range, 3 to 72). Their respective overall survival (OS) rates were, respectively, 82%, 52%, and 59% (P = .04). Secondary acute myelogenous leukemia was seen in 5 patients after BEAM but was not seen in Gem-Bu-Mel and Bu-Mel cohorts (P = .004). Multivariate analyses showed independent adverse effects of an HDC regimen different from Gem-Bu-Mel (hazard ratio [HR] for EFS = 2.3, P = .0008; HR for OS = 2.7, P = .0005), positive PET at HDC (HR for EFS = 2.2, P = .004, HR for OS = 3.1, P = .0001), and >1 previous salvage line (HR for EFS = 1.9, P = .008, HR for OS = 1.8, P = .07). Gem-Bu-Mel improved outcomes in this cohort analysis of patients with refractory/poor-risk relapsed HL and merits evaluation in randomized phase III trials.
AB - More active high-dose chemotherapy (HDC) regimens are needed for refractory Hodgkin's lymphoma (HL). We report a cohort analysis of 180 consecutive patients with primary refractory or poor-risk relapsed HL treated with busulfan-melphalan (Bu-Mel) (n = 39), gemcitabine-busulfan-melphalan (Gem-Bu-Mel) (n = 84), or BEAM (BCNU, etoposide, ara-C, melphalan; n = 57) between 2005 and 2010. Their pre-HDC positron emission tomography (PET) scans were interpreted prospectively. Despite more prevalent poor-risk features in the Gem-Bu-Mel cohort, such as PET-positive tumors at HDC, tumors growing at HDC, extranodal disease, or bulky tumors at prior relapse, this cohort had improved outcomes compared with the Bu-Mel and BEAM cohorts, with event-free survival (EFS) rates of 57%, 33%, and 39%, respectively (P = .01), at median follow-up of the whole population of 36 months (range, 3 to 72). Their respective overall survival (OS) rates were, respectively, 82%, 52%, and 59% (P = .04). Secondary acute myelogenous leukemia was seen in 5 patients after BEAM but was not seen in Gem-Bu-Mel and Bu-Mel cohorts (P = .004). Multivariate analyses showed independent adverse effects of an HDC regimen different from Gem-Bu-Mel (hazard ratio [HR] for EFS = 2.3, P = .0008; HR for OS = 2.7, P = .0005), positive PET at HDC (HR for EFS = 2.2, P = .004, HR for OS = 3.1, P = .0001), and >1 previous salvage line (HR for EFS = 1.9, P = .008, HR for OS = 1.8, P = .07). Gem-Bu-Mel improved outcomes in this cohort analysis of patients with refractory/poor-risk relapsed HL and merits evaluation in randomized phase III trials.
KW - Autologous transplantation
KW - Gemcitabine
KW - High-dose chemotherapy
KW - Hodgkin
KW - Refractory
UR - http://www.scopus.com/inward/record.url?scp=84873724090&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84873724090&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2012.10.029
DO - 10.1016/j.bbmt.2012.10.029
M3 - Article
C2 - 23128322
AN - SCOPUS:84873724090
SN - 1083-8791
VL - 19
SP - 410
EP - 417
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 3
ER -