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Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin's lymphoma: identification of prognostic factors predicting outcome

Robinson, Stephen P.
Sureda, Anna
Canals, Carmen
Russell, Nigel
Caballero, Dolores
Bacigalupo, Andrea
Iriondo, Arturo
Cook, Gordon
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Published in Haematologica. 2009, vol. 94, no. 2, p. 230-238
Abstract BACKGROUND: The role of reduced intensity conditioning allogeneic stem transplantation (RICalloSCT) in the management of patients with Hodgkin's lymphoma remains controversial. DESIGN AND METHODS: To further define its role we have conducted a retrospective analysis of 285 patients with HL who underwent a RICalloSCT in order to identify prognostic factors that predict outcome. Eighty percent of patients had undergone a prior autologous stem cell transplantation and 25% had refractory disease at transplant. RESULTS: Non-relapse mortality was associated with chemorefractory disease, poor performance status, age >45 and transplantation before 2002. For patients with no risk factors the 3-year non-relapse mortality rate was 12.5% compared to 46.2% for patients with 2 or more risk factors. The use of an unrelated donor had no adverse effect on the non-relapse mortality. Acute graft versus host disease (aGVHD) grades II-IV developed in 30% and chronic GVHD in 42%. The development of cGVHD was associated with a lower relapse rate. The disease progression rate at one and five years was 41% and 58.7% respectively and was associated with chemorefractory disease and extent of prior therapy. Donor lymphocyte infusions were administered to 64 patients for active disease of whom 32% showed a clinical response. Eight out of 18 patients receiving donor lymphocyte infusions alone had clinical responses. Progression-free and overall survival were both associated with performance status and disease status at transplant. Patients with neither risk factor had a 3-year PFS and overall survival of 42% and 56% respectively compared to 8% and 25% for patients with one or more risk factors. Relapse within six months of a prior autologous transplant was associated with a higher relapse rate and a lower progression-free. CONCLUSIONS: This analysis identifies important clinical parameters that may be useful in predicting the outcome of RICaIICalloSCT in Hodgkin's lymphoma.
Keywords AdolescentAdultFemaleHematopoietic Stem Cell Transplantation/*methodsHodgkin Disease/diagnosis/*therapyHumansMaleMiddle AgedPrognosisRetrospective StudiesTransplantation Conditioning/*methodsTransplantation, HomologousTreatment OutcomeYoung Adult
PMID: 19066328
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ROBINSON, Stephen P. et al. Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin's lymphoma: identification of prognostic factors predicting outcome. In: Haematologica, 2009, vol. 94, n° 2, p. 230-238. doi: 10.3324/haematol.13441 https://archive-ouverte.unige.ch/unige:20064

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Deposited on : 2012-04-23

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