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Giulino-Roth L, O'Donohue T, Chen Z, Trippett TM, Klein E, Kernan NA, Kobos R, Prockop SE, Scaradavou A, Shukla N, Steinherz PG, Moskowitz AJ, Moskowitz CH, Boulad F. Outcome of children and adolescents with relapsed Hodgkin lymphoma treated with high-dose therapy and autologous stem cell transplantation: the Memorial Sloan Kettering Cancer Center experience. Leuk Lymphoma 2017; 59:1861-1870. [PMID: 29183202 DOI: 10.1080/10428194.2017.1403601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To evaluate outcomes and prognostic markers among children with relapsed Hodgkin lymphoma (HL) treated with autologous stem cell transplant (ASCT), we conducted a retrospective analysis of 36 consecutive pediatric patients treated at Memorial Sloan Kettering Cancer Center from 1989 to 2013. With a median follow-up of 9.6 years, the 10-year overall survival (OS) and event-free survival (EFS) were 74.1 and 67.1% respectively. Absence of B-symptoms, chemotherapy-sensitive disease, and transplant date after 1997 were each associated with superior EFS [HR 0.12 (p = .0015), 0.18 (p = .0039), and 0.17 (p = .0208), respectively]. Childhood Hodgkin International Prognostic Score at relapse (R-CHIPS) was calculated in a subset of patients (n = 22) and a lower score was associated with improved OS (HR 0.29, p = .0352) and a trend toward improved EFS (HR 0.38, p = .0527). In summary, ASCT results in durable remission for the majority of pediatric patients with relapsed HL. R-CHIPS should be evaluated in larger cohorts as a potential predictive tool.
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Affiliation(s)
- Lisa Giulino-Roth
- a Department of Pediatrics , Weill Cornell Medical College , New York , NY , USA.,b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Tara O'Donohue
- a Department of Pediatrics , Weill Cornell Medical College , New York , NY , USA.,b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Zhengming Chen
- c Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research , Weill Cornell Medical College , New York , NY , USA
| | - Tanya M Trippett
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Elizabeth Klein
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Nancy A Kernan
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Rachel Kobos
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Susan E Prockop
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Andromachi Scaradavou
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Neerav Shukla
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Peter G Steinherz
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Alison J Moskowitz
- d Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Craig H Moskowitz
- d Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Farid Boulad
- a Department of Pediatrics , Weill Cornell Medical College , New York , NY , USA.,b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
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Perales MA, Ceberio I, Armand P, Burns LJ, Chen R, Cole PD, Evens AM, Laport GG, Moskowitz CH, Popat U, Reddy NM, Shea TC, Vose JM, Schriber J, Savani BN, Carpenter PA. Role of cytotoxic therapy with hematopoietic cell transplantation in the treatment of Hodgkin lymphoma: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2015; 21:971-83. [PMID: 25773017 DOI: 10.1016/j.bbmt.2015.02.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 12/22/2022]
Abstract
The role of hematopoietic cell transplantation (HCT) in the therapy of Hodgkin lymphoma (HL) in pediatric and adult patients is reviewed and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the treatment recommendations. Treatment recommendations based on the evidence are included and were reached unanimously by a panel of HL experts. Both autologous and allogeneic HCT offer a survival benefit in selected patients with advanced or relapsed HL and are currently part of standard clinical care. Relapse remains a significant cause of failure after both transplant approaches, and strategies to decrease the risk of relapse remain an important area of investigation.
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Affiliation(s)
- Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Izaskun Ceberio
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Hematology Department, Hospital Universitario Donostia, Donostia, Spain
| | - Philippe Armand
- Division of Hematological Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Linda J Burns
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Robert Chen
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - Peter D Cole
- Department of Pediatrics, Albert Einstein College of Medicine and Department of Pediatric Hematology/Oncology, The Children's Hospital at Montefiore, Bronx, New York
| | - Andrew M Evens
- Department of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Ginna G Laport
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Craig H Moskowitz
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nishitha M Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas C Shea
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Julie M Vose
- Division of Hematology/Oncology, The Nebraska Medical Center, Omaha, Nebraska
| | - Jeffrey Schriber
- Cancer Transplant Institute, Virginia G Piper Cancer Center, Scottsdale, Arizona
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Midtreatment evaluation of lymphoma response to chemotherapy by volume perfusion computed tomography. J Comput Assist Tomogr 2014; 38:123-30. [PMID: 24378894 DOI: 10.1097/rct.0b013e3182a90ee7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to search for chemotherapy-induced perfusion changes of diffuse large B-cell lymphoma, follicular lymphoma, and Hodgkin lymphoma at midtreatment versus baseline volume perfusion computed tomography (VPCT). METHODS Forty-five consecutive patients with untreated diffuse large B-cell lymphoma, follicular lymphoma, and Hodgkin lymphoma received VPCT examinations of the tumor bulk at baseline and during chemotherapy (midtreatment). Blood flow (BF), blood volume (BV), and transit constant (K-trans) were determined. Treatment response was categorized according to the Cheson criteria into complete or partial remission and stable or relapsed/progressive disease. RESULTS Midtreatment follow-up showed a reduction in BF, BV, and K-trans in all lymphoma subtypes compared with baseline. The reduction in BV was less pronounced in larger tumors. Notably, BF, BV, and K-trans decreased in the responders (complete remission/partial remission) when compared with the nonresponders (stable or relapsed/progressive disease). Less than 10% reduction in BF was shown to be the best VPCT criterion for the identification of nonresponse. CONCLUSIONS Chemotherapy-induced perfusion changes in responders are recognizable at midtreatment VPCT.
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William BM, Loberiza FR, Whalen V, Bierman PJ, Bociek RG, Vose JM, Armitage JO. Impact of conditioning regimen on outcome of 2-year disease-free survivors of autologous stem cell transplantation for Hodgkin lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:417-23. [PMID: 23773453 DOI: 10.1016/j.clml.2013.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/09/2013] [Accepted: 03/27/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Autologous stem cell transplantation is the standard of care for patients with relapsed HL and the long-term outcomes for survivors 2 years after ASCT have not been well described. No prospective trials have compared the effect of different conditioning regimens on outcomes. PATIENTS AND METHODS We searched the Nebraska Lymphoma Study Group database to identify patients with HL who received ASCT from 1984 to 2007. Patients were conditioned with either CBV (cyclophosphamide, carmustine, and etoposide) or BEAM (carmustine, etoposide, cytarabine, and melphalan). RESULTS At a median follow-up of 8 (range, 2-26) years, 225 patients were alive and disease-free 2 years after ASCT. Analysis was limited to these patients. At 5 years, the progression-free survival (PFS) was 92% for BEAM and 73% for CBV (P = .002) and the overall survival (OS) was 95% for BEAM and 87% for CBV (P = .07). At 10 years, the PFS was 79% for BEAM and 59% for CBV (P = .01) and the OS was 84% for BEAM and 66% for CBV (P = .02). CONCLUSION Patients with HL who are disease-free and alive 2 years after ASCT have favorable outcomes. We observed lower risk of progression and longer survival associated with use of BEAM vs. CBV. Patients in the BEAM group received a transplant in more recent years so we cannot exclude the possibility that the superior outcomes seen in the BEAM group are because of better supportive care, use of peripheral blood stem cell grafts, or improvements in salvage therapies before transplantation.
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Affiliation(s)
- Basem M William
- Department of Internal Medicine Division of Oncology/Hematology, University of Nebraska Medical Center, Omaha, NE, USA.
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Shafer JA, Heslop HE, Brenner MK, Carrum G, Wu MF, Liu H, Ahmed N, Gottschalk S, Kamble R, Leung KS, Myers GD, Bollard CM, Krance RA. Outcome of hematopoietic stem cell transplant as salvage therapy for Hodgkin's lymphoma in adolescents and young adults at a single institution. Leuk Lymphoma 2010; 51:664-70. [PMID: 20367182 DOI: 10.3109/10428190903580410] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
For patients with relapsed Hodgkin's lymphoma (HL), high dose chemotherapy with stem cell rescue (HDCT-SCT) may improve survival over chemotherapy alone. We assessed the outcomes of HDCT-SCT in 37 consecutive adolescent and young adult patients with relapsed HL whose malignancy was categorized based on sensitivity to chemotherapy. We determined whether current outcomes supported the use of HDCT-SCT in all of our patients or just those patients with lower-risk characteristics such as chemosensitivity. With a median follow-up of 6.5 years, the 2-year overall survival (OS) was 89% (95% CI: 62-97%) for the chemosensitive patients (n = 21), whereas for patients with resistant disease (n = 16), OS was 53% (95% CI: 25-74%). Both autologous and allogeneic transplants were well tolerated, with 100-day treatment-related mortality under 10%. Our data show encouraging outcomes for patients with chemosensitive relapsed HL who receive hematopoietic stem cell transplant (HSCT) and support the value of the procedure even when the disease is chemoresistant.
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Affiliation(s)
- J A Shafer
- Center for Cell and Gene Therapy, Houston, TX 77030, USA
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Cavalieri E, Matturro A, Annechini G, De Angelis F, Frattarelli N, Gentilini F, Grapulin L, Sacco M, Torelli F, Vignetti M, Mandelli F, Foà R, Pulsoni A. Efficacy of the BEACOPP regimen in refractory and relapsed Hodgkin lymphoma. Leuk Lymphoma 2010; 50:1803-8. [PMID: 19860621 DOI: 10.3109/10428190903254383] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The BEACOPP regimen is a consolidated first-line treatment regimen for advanced stage Hodgkin lymphoma (HL), while few data are available on the efficacy of this regimen in advanced disease. About 50% of patients with HL relapsed after or refractory to first-line therapy achieve a durable response after peripheral blood stem cell transplantation (PBSCT). Patients relapsing after a PBSCT (performed as second line therapy) have a very poor prognosis. We evaluated the efficacy of BEACOPP in two settings: patients refractory or in relapse after first-line therapy (Group A) and patients relapsing after a PBSCT (Group B). Twenty-three patients with HL, admitted between February 2003 and April 2007, were retrospectively studied: 10 patients in Group A and 13 in Group B. Group A: Nine complete remissions (CR) and one partial remission (PR) were achieved following BEACOPP treatment. After a median follow-up of 32 months, one patient has died due to secondary leukemia, while the other eight are alive, five (50%) in second CR, three in third CR after PBSCT and one with disease. Group B: Eight of the 13 patients (62%) obtained a CR, one patient a PR, two were refractory and two have died of toxicity. To date, eight patients (62%) are alive, four (31%) still in CR. All patients experienced hematologic toxicity (WHO 3-4) with two deaths due to septic shock. These results show that BEACOPP is an effective regimen for both refractory/relapsed patients with HL after first-line treatment (Group A) and for patients relapsing after a PBSCT (Group B) with a 3-year probability of overall survival, progression-free survival, and cumulative incidence of relapse of 90, 50, and 33.3% in Group A, and 61, 31, and 37.5% in Group B, respectively.
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Affiliation(s)
- Elena Cavalieri
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
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Labonté L, Li Y, Yang L, Gillingham A, Halpenny M, Giulivi A, Sills T, Evans K, Zanke B, Allan DS. Increased plasma EPO and MIP-1α are associated with recruitment of vascular progenitors but not CD34(+) cells in autologous peripheral blood stem cell grafts. Exp Hematol 2009; 37:673-8. [PMID: 19463769 DOI: 10.1016/j.exphem.2009.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 02/05/2009] [Accepted: 02/18/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Laura Labonté
- Sprott Centre for Stem Cell Research, Regenerative Medicine Program, Ottawa Health Research Institute, Ottawa, Canada
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Seshadri T, Pintilie M, Keating A, Crump M, Kuruvilla J. The relationship between absolute lymphocyte count with PFS in patients with Hodgkin's lymphoma undergoing autologous hematopoietic cell transplant. Bone Marrow Transplant 2008; 42:29-34. [PMID: 18332908 DOI: 10.1038/bmt.2008.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Previous reports in Hodgkin's lymphoma (HL) patients undergoing autologous hematopoietic cell transplantation (AHCT) have demonstrated a significant association between the absolute lymphocyte count at day 15 (ALC-15) with survival. To evaluate this finding further, we analyzed 146 patients with relapsed/refractory HL who underwent AHCT to evaluate the relationship between lymphocyte counts at apheresis and at two time points (days 15 and 90) after AHCT with PFS. We found no association between the ALC-15 and the ALC-90 with PFS. We found lymphocyte counts at apheresis and disease sensitive to salvage chemotherapy were predictive of PFS. In conclusion, our study does provide some support for the theory that the immune system may be important in disease control but further and more detailed studies in this area are required.
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Affiliation(s)
- T Seshadri
- Autologous Blood and Marrow Transplant Programme, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
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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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