Primary refractory hodgkin lymphoma and autologous stem cell transplantation: results of the single-center prospective study


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Today the role of single or double Autologous Stem Cell Transplantation (ASCT) in patients (pts) with refractory Hodgkin Lymphoma (HL) is still unclear. Aim. To present the results of a single-center prospective trial which aim was to show the significance of single and double ASCT in patients with HL, who did not achieve complete response after first-line chemotherapy. Material and Methods. Between 2007 and 2014 62 patients were enrolled in the study. First ASCT was administered to 53 patients, 10 of those 53 patients received second ASCT. Results. 5-year overall survival (OS) and progression-free survival (PS) were 52 and 27% after single ASCT versus 38 and 30% after double ASCT respectively. According to our study extensive previous treatment (radiotherapy and chemotherapy) followed by ASCT had a negative prognostic impact on overall survival (OS) (p=0.03). Moreover, initial response to the first ASCT was found to be an independent prognostic factor of OS (p=0.004). According to our results, achievement ofpartial response or disease stabilization after the first ASCT was the main indication for double ASCT. In this case second ASCT is preferable to alternative treatment (p=0.004). Disease progression (PD) after the first ASCT seems to be a contraindication to the necessity of the second course of ASCT as low effectiveness and high level of toxicity do not improve treatment results in comparison to alternative treatment (p=0.6). Achievement of complete remission associated with disease free long-term survival and high quality of life. Achievement of complete remission was crucial at any treatment stage. Conclusion. ASCT is an effective treatment option for patients who never achieved CR. Second ASCT is a treatment of choice for patients with PR/SD after 1st ASCT. Nevertheless second ASCT does not improve outcome for patients with PD after 1st ASCT. Alternative variants of treatment are needed for this patient group.

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Galina Petrova

N.N. Blokhin Russian Cancer Research Center

Email: galina_petrova@bk.ru
MD 115478, Moscow, Russian Federation

K. Melkova

N.N. Blokhin Russian Cancer Research Center

115478, Moscow, Russian Federation

T. Chernyavskaya

N.N. Blokhin Russian Cancer Research Center

115478, Moscow, Russian Federation

N. Gorbunova

N.N. Blokhin Russian Cancer Research Center

115478, Moscow, Russian Federation

B. Afanas'ev

I.P. Pavlov St.Petersburg State Medical University

R.M. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation 197022, St.Petersburg, Russian Federation

E. Demina

N.N. Blokhin Russian Cancer Research Center

115478, Moscow, Russian Federation

V. Kostrykina

N.N. Blokhin Russian Cancer Research Center

115478, Moscow, Russian Federation

V. Doronin

N.N. Blokhin Russian Cancer Research Center

115478, Moscow, Russian Federation

参考

  1. Eichenauer D.A., Boll B., Diehl V. Pharmacotherapy of Hodgkin lymphoma: standard approaches and future perspectives. Expert Opin. Pharmacother. 2014; 15(8): 1139-51.
  2. Демина Е.А., Тумян Г.С., Трофимова О.П., Иванов С.М., Кондратьева Н.Е., Унукова Н.Е. и др. Лимфома Ходжкина: лечение больных неблагоприятной группы. Практическая онкология. 2007; 8(2): 82-9.
  3. Linch D.C., Winfield D., Goldstone A.H. Moir D., Hancock B., McMillan A. et al. Dose intensification with autologous bone marrow transplantation in relapsed and resistant Hodgkin’s disease: Results of a BNLI randomized trial. Lancet. 1993; 341(8852): 1051-4.
  4. Schmitz N., Pfistner B., Sextro M., Sieber M., Carella A.M., Haenel M. et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy requiring autologous haemopoietic stem cell transplantation for relapsed chemosensitive Hodgkin’s disease: A randomised trial. Lancet. 2002; 359(9323): 2065-71.
  5. Constans M., Sureda A., Terol M.J., Arranz R., Caballero M.D., Iriondo A. et al. Autologous stem cell transplantation for primary refractory Hodgkin’s disease: Results and clinical variables affecting outcome. Ann. Oncol. 2003; 14(5): 745-51.
  6. Passweg J.R., Baldomero H., Peters C., Gaspar H.B., Cesaro S., Dreger P. et al. Hematopoietic SCT in Europe: data and trends in 2012 with special consideration of pediatric transplantation. Bone Marrow Transplant. 2014; 49(6): 744-50.
  7. Castagna L., Carlo-Stella C., Mazza R., Santoro A. Current role of autologous and allogeneic stem cell transplantation for relapsed and refractory hodgkin lymphoma. Mediterr. J. Hematol. Infect. Dis. 2015; 7(1): e2015015.
  8. Younes A., Gopal A.K., Smith S.E., Ansell S.M., Rosenblatt J.D., Savage K.J. et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin’s lymphoma. J. Clin. Oncol. 2012; 30(18): 2183-9.
  9. Barlogie B., Jagannath S., Vesole D.H., Naucke S., Cheson B., Mattox S. et al. Superiority of tandem autologous transplantation over standard therapy for previously untreated multiple myeloma. Blood. 1997; 89(3): 789-93.
  10. Mills W., Chopra R., McMillan A., Pearce R., Linch D.C., Goldstone A.H. BEAM chemotherapy and autologous bone marrow transplantation for patients with relapsed or refractory non-Hodgkin’s lymphoma. J. Clin. Oncol. 1995; 13(3): 588-95.
  11. Castagna L., Crocchiolo R., Giordano L., Bramanti S., Carlo-Stella C., Sarina B. et al. High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant. Bone Marrow Transplant. 2015; Jan 26. doi: 10.1038/bmt.2014.304. [Epub ahead of print]
  12. Cheson B.D., Horning S.J., Coiffier B., Shipp M.A., Fisher R.I., Connors J.M. et al. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J. Clin. Oncol. 1999; 17(4): 1244-53.
  13. Melkova K., Chernyavskaya T., Abdusalamov S., Grivtsova L., Tupitsyn N. Application of autologous stimulated bone marrow as a source of hematopoietic material for transplantation. Cell. Ther. Transplant. 2011; 3(12): 33.
  14. Ballestrero А., Clavio M., Ferrando F., Gonella R., Garuti A., Sessarego M. et al. High-dose chemotherapy with tandem autologous transplantation as part of the initial therapy for aggressive non-Hodgkin’s lymphoma. Int. J. Oncol. 2000; 17(5): 1007-13.
  15. Wilson W.H., Jain V, Bryant G., Cowan K.H., Carter C., Cottler-Fox M. et al. Phase I and II study of high-dose ifosfamide, carboplatin, and etoposide with autologous bone marrow rescue in lymphomas and solid tumors. J. Clin. Oncol. 1992; 10(11): 1712-22.
  16. Абдусаламов С.Н., Мелкова К.Н., Горбунова Н.В., Чернявская Т.З. Профилактические режимы ведения больных и подходы к оптимизации сопроводительной терапии при трансплантации костного мозга. Клиническая онкогематология. 2010; 3(1): 21-9.

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