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Akhtar S, Rauf MS, Elhassan TAM, Khan ZA, Elshenawy MA, Maghfoor I. Impact of risk factors and long term survival analysis of patients with primary refractory Hodgkin lymphoma who underwent high dose chemotherapy and autologous stem cell transplant. Transplant Cell Ther 2023:S2666-6367(23)01232-0. [PMID: 37031748 DOI: 10.1016/j.jtct.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Patients with primary refractory Hodgkin lymphoma (ref-HL) can still be salvaged with high dose chemotherapy (HDC) and autologous stem cell transplantation (auto-SCT). Outcome of patients with ref-HL is poorer than those with relapsed HL, but most studies have included patients with both relapsed and refractory diseases, and separate analyses or studies on patients with ref-HL are limited. OBJECTIVE This study aimed to evaluate the outcomes of HDC auto-SCT and impact of various prognostic factors on patients with ref-HL both at the time of primary treatment failure and also on subsequent survival at the time of failure post HDC auto-SCT. STUDY DESIGN This was a retrospective, single-institution, cohort analysis using HDC and auto-SCT database, approved by the Institutional Research Advisory Counsel and Ethics Committee for identifying patients. We used Fine and Gray competing risk analysis method, regression model for outcome analysis and Kaplan-Meier method (KM) for survival. RESULTS Two hundred consecutive ref-HL patients underwent HDC auto-SCT between 1996 to 2019. Median age was 22.75 years, median follow-up 106 months. Post auto-SCT, disease status was complete remission (CR), partial remission, and progressive disease in 122 (61%), 22 (11%), and 47 (23.5%) patients, respectively. KM median progression-free survival (PFS) after auto-SCT was 43.9 months (5:10 years, 49.3%:45.5%). Median overall survival (OS) was 168.6 months (5:10 years, 61.2%:56.2%). Eighty-five patients (44.5%) died - 69 (34.5%) due to disease. For both PFS and OS, multivariate analysis identified similar adverse factors. For PFS, stage III-IV at relapse (HR=1.65, P=0.045), mediastinal involvement (HR=2.01, P=0.009), and no CR after salvage chemotherapy (HR=2.2, P=0.001) as adverse factors. PFS with 0-1 (not reached), 2 (40.8), 3 adverse factors (5.4 months) were significant (p<0.001). For OS, stage III-IV at relapse (HR=1.68, P=0.045), mediastinal involvement (HR=2.52, P=0.007), and no CR after salvage chemotherapy (HR=2.15, P=0.004) were significant. OS with 0-1 (not reached), 2 (148.5) 3 adverse factors (34.4 months) were significant (p<0.001). Median OS after auto-SCT failure was 23.6 months; patients received post auto-SCT brentuximab/second SCT (not reached), other treatments (22.5 months), and supportive care (8.4) (p<0.001). OS with five risk factors, present at HDC auto-SCT failure, (stage III-IV, failure <12 months, tumor >5 cm, B-symptoms, low albumin) showed that 0-1:2:3-5 risk factors had 152:30.9:9.45 months OS (p<0.001). CONCLUSION Ref-HL patients have encouraging survival after HDC auto-SCT and can even be salvaged after auto-SCT failure. Based on prognostic factors, survival prediction is possible. Patients who fail to respond to HDC auto-SCT may benefit from newer treatments strategies and may qualify for enrollment in clinical trials.
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Affiliation(s)
- Saad Akhtar
- Oncology Center, King Abdullah Centre for Oncology and Liver Diseases. King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh 11211, Kingdom of Saudi Arabia; Professor, Collage of Medicine, AlFaisal University, Riyadh.
| | - M Shahzad Rauf
- Oncology Center, King Abdullah Centre for Oncology and Liver Diseases. King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh 11211, Kingdom of Saudi Arabia.
| | - Tusneem Ahmed M Elhassan
- Oncology Center, King Abdullah Centre for Oncology and Liver Diseases. King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh 11211, Kingdom of Saudi Arabia.
| | | | - Mahmoud A Elshenawy
- Oncology Center, King Abdullah Centre for Oncology and Liver Diseases. King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh 11211, Kingdom of Saudi Arabia; Clinical Oncology Department, Faculty of Medicine, Menoufia University, Shebin El Kom 32511, Egypt.
| | - Irfan Maghfoor
- Oncology Center, King Abdullah Centre for Oncology and Liver Diseases. King Faisal Specialist Hospital and Research Center, P.O. Box 3354, MBC# 64, Riyadh 11211, Kingdom of Saudi Arabia.
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Zinzani PL, Chen R, Armand P, Johnson NA, Brice P, Radford J, Ribrag V, Molin D, Vassilakopoulos TP, Tomita A, von Tresckow B, Shipp MA, Lin J, Nahar A, Balakumaran A, Moskowitz CH. Pembrolizumab monotherapy in patients with primary refractory classical hodgkin lymphoma who relapsed after salvage autologous stem cell transplantation and/or brentuximab vedotin therapy: KEYNOTE-087 subgroup analysis. Leuk Lymphoma 2020; 61:950-954. [PMID: 31905294 DOI: 10.1080/10428194.2019.1702178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology "Seràgnoli", University of Bologna, Bologna, Italy
| | - Robert Chen
- Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Philippe Armand
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Pauline Brice
- Hematology-Oncology, Hôpital Saint-Louis, Paris, France
| | - John Radford
- Division of Cancer Sciences, The University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | | | - Daniel Molin
- Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - Theodoros P Vassilakopoulos
- Hematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Akihiro Tomita
- Hematology and Oncology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Bastian von Tresckow
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
| | - Margaret A Shipp
- Hematologic Neoplasia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jianxin Lin
- Medical Oncology, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Akash Nahar
- Medical Oncology, Merck & Co., Inc, Kenilworth, NJ, USA
| | | | - Craig H Moskowitz
- Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
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High dose chemotherapy and autologous stem cell transplantation in relapsed or refractory Hodgkin lymphoma: Emerging questions, newer agents, and changing paradigm. Hematol Oncol Stem Cell Ther 2017. [DOI: 10.1016/j.hemonc.2017.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Akhtar S, Rauf SM, Elhassan TAM, Maghfoor I. Outcome analysis of high-dose chemotherapy and autologous stem cell transplantation in adolescent and young adults with relapsed or refractory Hodgkin lymphoma. Ann Hematol 2016; 95:1521-35. [PMID: 27376363 DOI: 10.1007/s00277-016-2736-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/19/2016] [Indexed: 11/24/2022]
Abstract
High-dose chemotherapy (HDC) and autologous stem cell transplantation (auto-SCT) can salvage many patients with relapsed or refractory Hodgkin's lymphoma (HL). We are reporting the outcome of HDC auto-SCT and the impact of 21 prognostic factors in relapsed and refractory adolescent (14-21 years) and young adult (>21-30 years) (AYA) HL patients. We used Fine and Gray's competing risk analysis method and regression model for outcome analysis. From 1996 to 2013, 290 consecutive patients with biopsy-proven HL underwent HDC auto-SCT for relapsed/refractory HL; 216 patients (74.5 %) were AYA at the time of auto-SCT. Male/female were equal, median age at auto-SCT was 22.4 years, and there were 94 adolescent (43.5 %) and 122 young adults (56.5 %). There was refractory disease in 121 (56 %) patients, relapsed in 95 (44 %). Median follow-up was 72.6 months. The Kaplan-Meier method estimated that 5-year overall survival is 62.7 % (adolescents (63.5 %), young adults (62 %)) and event-free survival was 51.3 %. Five-year cumulative incidence of disease-specific death (DS-death) is 33 % and that of DS-event is 45 %. For DS-death, the multivariate analysis identified complete remission (CR) duration of <12 months (hazard ratio (HR) 3.61, P = 0.0009), no CR after salvage (HR: 3.93, P = 0.0002), and nodular sclerosis pathology (HR 3.3, P = 0.016) and positive B symptoms (HR 2, P = 0.028) as negative factors. For DS-event, CR duration of <12 months (HR 1.88, P = 0.02), no CR after salvage (HR 3.47, P = 0.000005) and nodular sclerosis pathology (HR 1.88, P = 0.02) were found significant. The Kaplan-Meier method estimated overall survival (OS) at 36 months with 0-2:3:4 factors being 93.6:54:21 %, respectively (P value <0.001). Kaplan-Meier estimated event-free survival (EFS) at 36 months with 0-1:2:3 factors being 84.6:65:31 %, respectively (P value <0.001). Clinically, adolescents have similar outcomes as young adults.
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Affiliation(s)
- Saad Akhtar
- King Faisal Specialist Hospital and Research Center, Oncology Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia.
| | - Shahzad M Rauf
- King Faisal Specialist Hospital and Research Center, Oncology Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Tusneem A M Elhassan
- King Faisal Specialist Hospital and Research Center, Oncology Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Irfan Maghfoor
- King Faisal Specialist Hospital and Research Center, Oncology Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
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Bröckelmann PJ, Angelopoulou MK, Vassilakopoulos TP. Prognostic factors in Hodgkin lymphoma. Semin Hematol 2016; 53:155-64. [DOI: 10.1053/j.seminhematol.2016.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sakellari I, Mallouri D, Batsis I, Apostolou C, Konstantinou V, Abela EM, Douka V, Marvaki A, Karypidis K, Iskas M, Baliakas P, Kaloyannidis P, Yannaki E, Sotiropoulos D, Kouvatseas G, Smias C, Anagnostopoulos A. Carmustine, etoposide, cytarabine and melphalan versus a newly designed intravenous busulfan-based Busulfex, etoposide and melphalan conditioning regimen for autologous hematopoietic cell transplant: a retrospective matched-pair analysis in advanced Hodgkin and non-Hodgkin lymphomas. Leuk Lymphoma 2015; 56:3071-81. [DOI: 10.3109/10428194.2015.1028054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Current role of autologous and allogeneic stem cell transplantation for relapsed and refractory hodgkin lymphoma. Mediterr J Hematol Infect Dis 2015; 7:e2015015. [PMID: 25745542 PMCID: PMC4344175 DOI: 10.4084/mjhid.2015.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/19/2015] [Indexed: 11/25/2022] Open
Abstract
Classical Hodgkin lymphoma (cHL) is a relatively rare disease, with approximately 9,200 estimated new cases and 1,200 estimated deaths per year in the United States. First-line chemo-radiotherapy leads to cure rates approaching 80% in patients with advanced-stage disease. However, 25 to 30% of these patients are not cured with chemotherapy alone (i.e., the ABVD regimen) and show either primary refractoriness to chemotherapy, early disease relapse or late disease relapse. Second-line salvage high-dose chemotherapy (HDC) and autologous stem cell transplantation (SCT) have an established role in the management of refractory/relapsed cHL, leading to durable responses in approximately 50% of relapsed patients and a minority of refractory patients. However, due to the poor responses to second-line salvage chemotherapy and dismal long-term disease control of primary refractory and early relapsed patients, their treatment represents an unmet medical need. Allogeneic SCT represents, by far, the only strategy with a curative potential for these patients; however, as discussed in this review, it’s role in cHL remains controversial. Despite a general consensus that early relapsed and primary refractory patients represent a clinical challenge requiring effective treatments to achieve long-term disease control, there has been no consensus on the optimal therapy that should be offered to these patients. This review will briefly discuss the clinical results and the main issues regarding autologous SCT as well as the current role of allogeneic SCT.
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High-dose chemotherapy and auto-SCT for relapsed and refractory Hodgkin’s lymphoma patients refractory to first-line salvage chemotherapy but responsive to second-line salvage chemotherapy. Med Oncol 2014; 32:388. [DOI: 10.1007/s12032-014-0388-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
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Abstract
Patients with Hodgkin lymphoma (HL) who relapse following effective front-line therapy are offered salvage second-line chemotherapy regimens followed by high-dose therapy and autologous stem cell transplantation (HDT/ASCT). Randomized studies comparing HDT/ASCT with conventional chemotherapy in patients with relapsed refractory HL have shown significant improvement in progression-free survival and freedom from treatment failure but were not powered to show improvements in overall survival. For patients who relapse after salvage HDT/ASCT, novel therapies exist as a bridge to allogeneic SCT. In this article, we review indications and results of autologous and allogeneic SCT in HL.
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Affiliation(s)
- Nishitha M Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, 3927 The Vanderbilt Clinic, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Miguel-Angel Perales
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 298, New York, NY 10065, USA.
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Shankar A, Hayward J, Kirkwood A, McCarthy K, Hewitt M, Morland B, Daw S. Treatment outcome in children and adolescents with relapsed Hodgkin lymphoma--results of the UK HD3 relapse treatment strategy. Br J Haematol 2014; 165:534-44. [PMID: 24754633 DOI: 10.1111/bjh.12768] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 12/15/2013] [Indexed: 12/01/2022]
Abstract
The purpose of this national retrospective study was to evaluate the outcome in children with relapsed or primary refractory Hodgkin lymphoma [HL] after a primary chemotherapy alone treatment strategy. Between 2000 and 2005, 80 children with relapsed [n = 69] or primary refractory [n = 11] HL were treated on a standardized treatment protocol of 4-6 cycles of EPIC [etoposide, prednisolone, ifosfamide and cisplatin] chemotherapy. Radiotherapy was recommended to all relapsed sites. High dose therapy with stem cell rescue [SCT] was recommended for patients with poor response. The 5-year overall survival [OS] and progression-free survival from relapse was 75·8% [64·8-83·9] and 59·9% [48·3-69·7] respectively. Duration of first remission was strongly associated with OS; risk of death was decreased by 53% [Hazard ratio (HR): 0·47, 95% confidence interval (CI): 0·19-1·18] for those with a time from end of treatment to relapse of 3-12 months (compared to <3 months) and reduced by 80% (HR 0·20, 95% CI: 0·04-0·90) for those >12 months after end of treatment. Other poor prognostic factors included advanced stage disease at relapse and B symptoms at first diagnosis. The most important factor associated with salvage failure was time to relapse. Survival outcome in children with primary refractory HL is poor.
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Affiliation(s)
- Ananth Shankar
- Department Paediatric & Adolescent Oncology, University College London Hospital NHS Foundation Trust, London, UK
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Akhtar S, Al-Sugair AS, Abouzied M, AlKadhi Y, Dingle M, Abdelsalam M, Soudy H, Darwish A, Eltigani A, Elhassan TAM, Nabil-Ahmed M, Maghfoor I. Pre-transplant FDG-PET-based survival model in relapsed and refractory Hodgkin’s lymphoma: outcome after high-dose chemotherapy and auto-SCT. Bone Marrow Transplant 2013; 48:1530-6. [DOI: 10.1038/bmt.2013.88] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 02/11/2013] [Accepted: 03/19/2013] [Indexed: 11/09/2022]
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Sibon D, Ertault M, Al Nawakil C, de Bazelaire C, Franchi P, Brière J, de Kerviler E, Beranger N, Thieblemont C, Brice P. Combined ifosfamide, etoposide and oxalipatin chemotherapy, a low-toxicity regimen for first-relapsed or refractory Hodgkin lymphoma after ABVD/EBVP: a prospective monocentre study on 34 patients. Br J Haematol 2011; 153:191-8. [DOI: 10.1111/j.1365-2141.2011.08594.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Relapsed or refractory Hodgkin lymphoma is a challenging problem for clinicians who treat hematologic malignancies. The standard management of these patients should include the use of salvage chemotherapy followed by autologous stem cell transplant (ASCT) in patients who are chemotherapy sensitive. Open issues in this area include the role of functional imaging, the specific chemotherapy regimen to be used before ASCT, and the role of consolidative radiotherapy. Some patients will not be eligible for ASCT, and alternative approaches with conventional chemotherapy alone or with salvage radiotherapy should be considered. Prognostic factors for relapsed/refractory disease have been identified but generally are not used as a part of risk-adapted therapy. Allogeneic transplantation may offer the potential of a graft-versus-lymphoma effect, but this therapy has significant toxicity and results in few long-term disease-free survivors; hence, it should only be offered in the context of disease-specific clinical trials. An expanding list of novel drugs has exhibited promising single-agent activity. Patients have effective options beyond primary therapy, and continued progress through controlled trials remains a tangible goal in the treatment of relapsed and refractory disease.
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Puig N, Pintilie M, Seshadri T, Al-Farsi K, Nagy T, Franke N, Tsang R, Keating A, Crump M, Kuruvilla J. Different response to salvage chemotherapy but similar post-transplant outcomes in patients with relapsed and refractory Hodgkin's lymphoma. Haematologica 2010; 95:1496-502. [PMID: 20460643 DOI: 10.3324/haematol.2009.019943] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The use of high-dose chemotherapy and autologous stem-cell transplantation in patients with relapsed Hodgkin's lymphoma is supported by two randomized clinical trials but its benefit in patients with primary refractory disease is less clear. Aiming to shed light on this issue, we analyzed and compared the outcomes of patients with relapsed or refractory Hodgkin's lymphoma treated with second-line chemotherapy and planned autologous stem-cell transplantation. DESIGN AND METHODS We retrospectively analyzed data on 157 consecutive patients with Hodgkin's lymphoma referred to our institution for consideration of autologous stem-cell transplantation between 1999 and 2006. Of those, 73 met the definition of having primary refractory disease, ie. progressive disease during first line chemotherapy or within 3 months of completion of the treatment. Those patients achieving complete remission, partial remission and stable disease with symptomatic improvement after two or three cycles of salvage chemotherapy proceeded to stem cell mobilization and autologous transplantation. RESULTS From first relapse/progression, the 3-year overall survival was 76% (95% CI: 66%-89%) for the refractory cohort and 91% (95% CI: 84%-98%) for the relapsed cohort (P=0.034); the overall response rate to second-line chemotherapy was 51% and 83% (P<0.0001), respectively. Three-year progression-free survival post-transplant was 49% in refractory patients and 67% in relapsed patients (P=0.21); overall survival was 75% and 91% (P=0.097), respectively. CONCLUSIONS Using the group with relapsed disease as a reference, we can conclude that the subset of patients with chemosensitive primary refractory Hodgkin's lymphoma do benefit from autologous stem-cell transplantation.
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Affiliation(s)
- Noemi Puig
- Division of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Avenue, Room 5-221, Toronto M5G 2M9, Canada
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Bien E, Balcerska A. Serum Soluble Interleukin-2 Receptor, Beta2-Microglobulin, Lactate Dehydrogenase and Erythrocyte Sedimentation Rate in Children with Hodgkin’s Lymphoma. Scand J Immunol 2009; 70:490-500. [DOI: 10.1111/j.1365-3083.2009.02313.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bien E, Rapala M, Krawczyk M, Balcerska A. The serum levels of soluble interleukin-2 receptor alpha and lactate dehydrogenase but not of B2-microglobulin correlate with selected clinico-pathological prognostic factors and response to therapy in childhood soft tissue sarcomas. J Cancer Res Clin Oncol 2009; 136:293-305. [PMID: 19693535 DOI: 10.1007/s00432-009-0661-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To establish the clinical utility of serum soluble IL-2 receptor (sIL-2R alpha), lactate dehydrogenase (LDH) [corrected] and B2-microglobulin [corrected] (B2-M) as markers for diagnosis, prognosis and treatment monitoring in childhood soft tissue sarcomas (STS). METHODS The markers[corrected] were measured prospectively before treatment, in complete remission (CR) during and after therapy and at relapse [corrected] in 35 children with STS and in 50 healthy children [corrected] (once). RESULTS Serum sIL-2R alpha and LDH [corrected] correlated with age thus they were [corrected] presented as multiplications [corrected] of the upper normal ranges [corrected] for age. Pre-treatment levels [corrected] of sIL-2R alpha and LDH [corrected] but not of B2-M exceeded significantly those of controls. [corrected] Elevated [corrected] sIL-2R alpha levels correlated with more [corrected] advanced stages, poor-risk histology and poor response to chemotherapy, higher LDH with incomplete primary tumour [corrected] resection and increased B2-M with poor-risk histology. [corrected] Patients' age >10 years, male gender and unfavourable tumour localisation were not accompanied by the markers' elevation. [corrected] None of the markers predicted EFS and OS. [corrected] Good response to chemotherapy was paralleled by significant decline of sIL-2R alpha and LDH pre-treatment levels while relapse--by sIL-2R alpha and LDH increase to values similar to those at diagnosis. [corrected] Monitoring of B2-M did not reflect the disease course. [corrected] CONCLUSIONS sIL-2R alpha and LDH were [corrected] proven to be promising markers [corrected] for diagnosis and treatment monitoring in children with STS. The markers [corrected] correlated also with some [corrected] important prognostic clinico-pathological factors for childhood [corrected] STS; however, they [corrected] failed to predict EFS and OS. Measurements of serum [corrected] B2-M were shown [corrected] to have no clinical value in the diagnostics, prognostics and treatment monitoring in paediatric STS.
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Affiliation(s)
- Ewa Bien
- Department of Paediatrics, Haematology, Oncology and Endocrinology, Medical University of Gdansk, 7 Debinki Street, 80-211, Gdansk, Poland.
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Intermediate dose gemcitabine-cisplatin combination chemotherapy without treatment delay for cytopenia followed by autografting--a new standard of care in relapsed or refractory Hodgkin lymphoma? Ann Hematol 2009; 88:1107-12. [PMID: 19418054 DOI: 10.1007/s00277-009-0734-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 03/09/2009] [Indexed: 10/20/2022]
Abstract
Ten percent to 20% of patients with Hodgkin Lymphoma (HL) are refractory to first-line therapy or relapse. Existing salvage regimens have response rates of 60-85%, considerable toxicity and frequent treatment delay or dose reduction. We report a gemcitabine, cisplatin, and dexamethasone regimen (GemCis) with intensive growth factor and platelet support and no treatment delay. Seventeen patients with relapsed or refractory biopsy proven HL were treated. Toxicity, transfusion requirement, stem cell harvesting and engraftment data were collected. Response assessment was by computed tomography and positron emission tomography. Overall and complete response rates were high (94% and 65%, respectively). There were no episodes of febrile neutropenia, treatment delays or hospital admissions. All 15 patients intended for autograft were successfully harvested. All engrafted successfully with a median time for the entire group to neutrophil engraftment of 14 days. With a median follow-up of 22 months, the median survival has not yet been reached, and the estimated 2-year survival is 88%. GemCis is a well-tolerated outpatient regimen for relapsed/ refractory Hodgkin lymphoma which does not inhibit stem cell mobilisation, gives excellent response rates and compares favourably with previously published salvage regimens using these or other chemotherapy agents.
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High-dose chemotherapy and autologous stem cell transplantation for Hodgkin's lymphoma in the kingdom of Saudi Arabia: King Faisal specialist hospital and research center experience. Bone Marrow Transplant 2008; 42 Suppl 1:S37-S40. [PMID: 18724297 DOI: 10.1038/bmt.2008.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report our experience with high-dose chemotherapy (HDC) and autologous SCT (ASCT) in 66 patients out of 113 (113 patients out of 153 had complete analysis) with primary refractory Hodgkin's lymphoma (PR-HL) who received salvage chemotherapy followed by BEAM as HDC. Median age at ASCT was 23 years. Before salvage chemotherapy, stages I:II:III:IV were 2:21:14:29, bulky disease 27%, involvement of mediastinum 79%, spleen 26% and extranodal site 47%; 92% had ESHAP (etoposide, methylprednisolone, high-dose cytarabine, cisplatin) as salvage. Post-ASCT evaluation showed response in 50 patients (76%), complete response (CR) in 37 (56%), partial response in 14 (21%), no response or stable disease in three (5%) and progressive disease in 10 (15%) patients. Six patients achieved CR after XRT (5) or surgery (1), making a total with CR of 43 (65%). From diagnosis and HDC, median follow-up is 38.5 and 22.8 months and median overall survival 78 and 57 months, respectively. EFS and overall survival (OS) are 36 and 64%, respectively. In all 47% patients are in CR. Twenty-two (33%) patients died of the disease. Multivariate analysis showed elevated lactic dehydrogenase (LDH) for EFS (P=0.041) and mediastinal involvement for OS (P=0.038) as negative prognostic factors. In conclusion, EFS and OS are only 36 and 64%, respectively. Elevated LDH and mediastinal involvement are poor prognostic factors.
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Abstract
The majority of patients with Hodgkin lymphoma (HL) can now expect to be cured with conventional chemo- and/or radio-therapy. However, a subgroup still exists that have poor outcomes, even following dose escalation and autologous stem cell transplantation. Furthermore, patients relapsing after autografting have limited therapeutic options available. Whilst the application of allogeneic transplantation strategies has historically been limited by prohibitive transplant-related mortality, the exploration of reduced intensity approaches has demonstrated the feasibility of delivering allogeneic immunotherapies with more acceptable mortality rates. Although its role remains controversial, we are beginning to re-evaluate the use of allogeneic transplantation in the management of patients with HL and to address a number of critical questions. These include whether a clinically relevant graft-versus-tumour response occurs in HL, and whether subgroups of patients who might benefit from allogeneic approaches can be identified in order to inform development of rational clinical studies. This review focuses on evaluating recent experience with reduced intensity allogeneic approaches in HL in order to inform opinion on its current role and to highlight areas for future investigation.
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Affiliation(s)
- Karl S Peggs
- Department of Haematology, University College London Cancer Institute, London, UK.
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Current Awareness in Hematological Oncology. Hematol Oncol 2008. [DOI: 10.1002/hon.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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