S Genadieva-Stavrik1, A Boumendil2, P Dreger2,3, K Peggs4, J Briones5, P Corradini6, A Bacigalupo7, G Socié8, F Bonifazi9, H Finel2, A Velardi10, M Potter11, B Bruno12, L Castagna13, R Malladi14, N Russell15, A Sureda16. 1. BMT Unit, University Hematology Clinic, Medical Faculty-Skopje, Skopje, Macedonia. 2. EBMT Lymphoma Working Party, Paris, France. 3. Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany. 4. Hematology, University College London Hospitals NHS Trust, London, UK. 5. Department of Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain. 6. IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano. 7. Hematology, Ospedale S. Martino, Genova, Italy. 8. Haematology, Hôpital Saint-Louis, Paris, France. 9. Hematology, Orsola-Malpighi University Hospital, Bologna. 10. Hematology, Ospedale Santa Maria della Misericordia, Perugia, Italy. 11. Hematology, The Royal Marsden Hospital, London and Surrey, UK. 12. Department of Hematology, Azienda Ospedaliera Univerzitaria Citta della Salute e della Sciencia, Torino. 13. Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milano, Italy. 14. Centre for Clinical Haematology, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham. 15. Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK. 16. Department of Hematology, Institut Català d'Oncologia-Hospital Duran I Reynals, Barcelona, Spain asureda@iconcologia.net.
Abstract
BACKGROUND: To evaluate long-term outcome of myeloablative allogeneic stem cell transplantation (allo-SCT) (MAC) versus reduced-intensity allo-SCT (RIC) in patients with relapsed/refractory Hodgkin's lymphoma (HL) in recent years. PATIENTS AND METHODS: A total of 312 patients (63 MAC and 249 RIC) with relapsed/refractory HL who received allo-SCT between 2006 and 2010 and were reported to the EBMT Database were included in the study. RESULTS: With a median follow-up for alive patients of 56 (26-73) months, there were no significant differences in non-relapse mortality (NRM) between MAC and RIC. Relapse rate (RR) was somewhat lower in the MAC group (41% versus 52% at 24 months, P = 0.16). This lower RR translated into a marginal improvement in event-free survival (EFS) for the MAC group (48% versus 36% at 24 months, P = 0.09) with no significant differences in overall survival (73% for MAC and 62% for RIC at 24 months, P = 0.13). Multivariate analysis after adjusting for disease status at the time of allo-SCT showed that the use of MAC was of borderline statistical significance for predicting a lower RR and EFS [HR 0.7, 95% CI (0.5-1.0), P = 0.1] and [HR 0.7, 95% CI (0.5-1.0), P = 0.07], respectively, after allo-SCT. CONCLUSIONS: With modern transplant practices, the NRM associated with MAC for HL has strongly decreased, resulting into non-significant improvement of EFS because of a somewhat better disease control compared with RIC transplants. The intensity of conditioning regimens should be considered when designing individual allo-SCT strategies or clinical trials in patients with relapsed/refractory HL.
BACKGROUND: To evaluate long-term outcome of myeloablative allogeneic stem cell transplantation (allo-SCT) (MAC) versus reduced-intensity allo-SCT (RIC) in patients with relapsed/refractory Hodgkin's lymphoma (HL) in recent years. PATIENTS AND METHODS: A total of 312 patients (63 MAC and 249 RIC) with relapsed/refractory HL who received allo-SCT between 2006 and 2010 and were reported to the EBMT Database were included in the study. RESULTS: With a median follow-up for alive patients of 56 (26-73) months, there were no significant differences in non-relapse mortality (NRM) between MAC and RIC. Relapse rate (RR) was somewhat lower in the MAC group (41% versus 52% at 24 months, P = 0.16). This lower RR translated into a marginal improvement in event-free survival (EFS) for the MAC group (48% versus 36% at 24 months, P = 0.09) with no significant differences in overall survival (73% for MAC and 62% for RIC at 24 months, P = 0.13). Multivariate analysis after adjusting for disease status at the time of allo-SCT showed that the use of MAC was of borderline statistical significance for predicting a lower RR and EFS [HR 0.7, 95% CI (0.5-1.0), P = 0.1] and [HR 0.7, 95% CI (0.5-1.0), P = 0.07], respectively, after allo-SCT. CONCLUSIONS: With modern transplant practices, the NRM associated with MAC for HL has strongly decreased, resulting into non-significant improvement of EFS because of a somewhat better disease control compared with RIC transplants. The intensity of conditioning regimens should be considered when designing individual allo-SCT strategies or clinical trials in patients with relapsed/refractory HL.
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