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Outcome analysis of high-dose chemotherapy and autologous stem cell transplantation in adolescent and young adults with relapsed or refractory Hodgkin lymphoma

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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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Acknowledgments

We appreciate Ms. Ruqaya Belkhedim, Mr. Fayez Abu Zeid, and Ms. Reena Ulahannan from BMT clinic; Mr. Edgardo Colcol, Riad Youniss, and Dr. Abida Rehman from Oncology Research Unit; and Ms. Iman Youssef, clinical nurse coordinator for their valuable contribution.

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  1. King Faisal Specialist Hospital and Research Center, Oncology Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia

    Saad Akhtar, Shahzad M. Rauf, Tusneem A. M. Elhassan & Irfan Maghfoor

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  1. Saad Akhtar
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  2. Shahzad M. Rauf
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  3. Tusneem A. M. Elhassan
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  4. Irfan Maghfoor
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Correspondence to Saad Akhtar.

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SA was the principal investigator, conducted analysis of the data, and takes primary responsibility for the paper; SR helped in the analysis of data and manuscript writing; TAME performed statistical analysis and helped in manuscript writing; and IM was the co-principal investigator and helped in data interpretation, analysis, and in manuscript writing.

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The authors declare that they have no conflict of interest.

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Akhtar, S., Rauf, S.M., Elhassan, T.A.M. et al. Outcome analysis of high-dose chemotherapy and autologous stem cell transplantation in adolescent and young adults with relapsed or refractory Hodgkin lymphoma. Ann Hematol 95, 1521–1535 (2016). https://doi.org/10.1007/s00277-016-2736-5

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