Long-Term Results of Autologous Stem Cell Transplantation for Primary Refractory or Relapsed Hodgkin’s Lymphoma

Abstract Autologous hematopoietic stem cell transplantation (ASCT) has become standard therapy for primary refractory (PR REF) or relapsed (REL) Hodgkin's lymphoma (HL); however, more than half of these patients eventually relapse and die of their disease. We studied long-term outcomes and evaluated factors influencing progression-free survival (PFS) in 141 patients with PR REF or REL HL who underwent ASCT between 1985 and 2003. Median age at ASCT was 30 years (range, 7–60 years); 21 patients had PR REF, and 120 had REL HL. With a median follow-up of 6.3 years (range, 1–20 years), the probability of PFS at 5 and 10 years was 48% (95% confidence interval [CI], 39%–57%) and 45% (95% CI, 36%–54%) and that of overall survival (OS) was 53% (95% CI, 44%–62%) and 47% (95% CI, 37%–57%), respectively. Transplant-related mortality at 100 days was 1.4%. Among 45 5- to 20-year survivors, no late relapses of HL were observed. In multivariate analysis, 3 factors were independently predictive of poor PFS: chemoresistant disease (relative risk [RR], 2.9; 95% CI, 1.7–5.0), B-symptoms at pretransplantation relapse (RR, 2.1; 95% CI, 1.3–3.4), and presence of residual disease at the time of transplantation (RR, 2.3; 95% CI, 1.1–4.8). Patients with 0 or 1 of these 3 adverse factors (low-risk disease) had a 5–year PFS of 67% (95% CI, 55%–79%) compared with 37% (95% CI, 22%–52%) in those with 2 factors (intermediate-risk group) and 9% (95% CI, 0–20%) in those with all 3 factors (high-risk group) ( P P