Long-term results of blood and marrow transplantation for Hodgkin's Lymphoma

G. Akpek, Richard F Ambinder, S. Piantadosi, R. A. Abrams, Robert A Brodsky, Georgia Boyce Vogelsang, M. L. Zahurak, D. Fuller, C. B. Miller, S. J. Noga, Ephraim J Fuchs, I. W. Flinn, P. O'Donnell, E. J. Seifter, R. B. Mann, Richard J Jones

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the long-term outcome after allogeneic (allo) and autologous (auto) blood or marrow transplantation (BMT) in patients with relapsed or refractory Hodgkin's lymphoma (HL). Patients and Methods: We analyzed the outcome of 157 consecutive patients with relapsed or refractory HL, who underwent BMT between March 1985 and April 1998. Patients ≤ age 55 with HLA-matched siblings were prioritized toward allo BMT. The median age was 28 years (range, 13 to 52 years) for the 53 allo patients and 30.5 years (range, 11 to 62 years) for the 104 auto patients. Results: The median follow-up after BMT for surviving patients was 5.1 years (range, 1 to 13.8 years). For the entire group, the probabilities of event-free survival (EFS) and relapse at 10 years were 26% (95% confidence interval [CI], 18% to 33%) and 58% (95% CI, 48% to 69%), respectively. According to multivariate analysis, disease status before BMT (sensitive relapse if responding to conventional-dose therapy or resistant disease if not) (hazard ratio [HR] = 0.39, P <.0001) and date of BMT (HR = 0.93, P = .004) were independent predictors of EFS, whereas only disease status (HR = 0.35, P <.0001) influenced relapse. There was a trend for probability of relapse in sensitive patients to be less after allo BMT at 34% (range, 8% to 59%) versus 51% (range, 36% to 67%) for the auto patients (HR = 0.51, P = .17). There was a continuing risk of relapse or secondary acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) for 12 years after auto BMT, whereas there were no cases of secondary AML/MDS or relapses beyond 3 years after allo BMT. Conclusion: There seems to be a clinical graft-versus-HL effect associated with allo BMT. Allo BMT for HL also seems to have a lower risk of secondary AML/MDS than auto BMT. Thus, allo BMT warrants continued study in HL.

Original languageEnglish (US)
Pages (from-to)4314-4321
Number of pages8
JournalJournal of Clinical Oncology
Volume19
Issue number23
StatePublished - Dec 1 2001

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Hodgkin Disease
Transplantation
Bone Marrow
Recurrence
Myelodysplastic Syndromes
Acute Myeloid Leukemia
Disease-Free Survival
Confidence Intervals
Siblings
Multivariate Analysis
Transplants

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Long-term results of blood and marrow transplantation for Hodgkin's Lymphoma. / Akpek, G.; Ambinder, Richard F; Piantadosi, S.; Abrams, R. A.; Brodsky, Robert A; Vogelsang, Georgia Boyce; Zahurak, M. L.; Fuller, D.; Miller, C. B.; Noga, S. J.; Fuchs, Ephraim J; Flinn, I. W.; O'Donnell, P.; Seifter, E. J.; Mann, R. B.; Jones, Richard J.

In: Journal of Clinical Oncology, Vol. 19, No. 23, 01.12.2001, p. 4314-4321.

Research output: Contribution to journalArticle

Akpek, G, Ambinder, RF, Piantadosi, S, Abrams, RA, Brodsky, RA, Vogelsang, GB, Zahurak, ML, Fuller, D, Miller, CB, Noga, SJ, Fuchs, EJ, Flinn, IW, O'Donnell, P, Seifter, EJ, Mann, RB & Jones, RJ 2001, 'Long-term results of blood and marrow transplantation for Hodgkin's Lymphoma', Journal of Clinical Oncology, vol. 19, no. 23, pp. 4314-4321.
Akpek, G. ; Ambinder, Richard F ; Piantadosi, S. ; Abrams, R. A. ; Brodsky, Robert A ; Vogelsang, Georgia Boyce ; Zahurak, M. L. ; Fuller, D. ; Miller, C. B. ; Noga, S. J. ; Fuchs, Ephraim J ; Flinn, I. W. ; O'Donnell, P. ; Seifter, E. J. ; Mann, R. B. ; Jones, Richard J. / Long-term results of blood and marrow transplantation for Hodgkin's Lymphoma. In: Journal of Clinical Oncology. 2001 ; Vol. 19, No. 23. pp. 4314-4321.
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abstract = "Purpose: To evaluate the long-term outcome after allogeneic (allo) and autologous (auto) blood or marrow transplantation (BMT) in patients with relapsed or refractory Hodgkin's lymphoma (HL). Patients and Methods: We analyzed the outcome of 157 consecutive patients with relapsed or refractory HL, who underwent BMT between March 1985 and April 1998. Patients ≤ age 55 with HLA-matched siblings were prioritized toward allo BMT. The median age was 28 years (range, 13 to 52 years) for the 53 allo patients and 30.5 years (range, 11 to 62 years) for the 104 auto patients. Results: The median follow-up after BMT for surviving patients was 5.1 years (range, 1 to 13.8 years). For the entire group, the probabilities of event-free survival (EFS) and relapse at 10 years were 26{\%} (95{\%} confidence interval [CI], 18{\%} to 33{\%}) and 58{\%} (95{\%} CI, 48{\%} to 69{\%}), respectively. According to multivariate analysis, disease status before BMT (sensitive relapse if responding to conventional-dose therapy or resistant disease if not) (hazard ratio [HR] = 0.39, P <.0001) and date of BMT (HR = 0.93, P = .004) were independent predictors of EFS, whereas only disease status (HR = 0.35, P <.0001) influenced relapse. There was a trend for probability of relapse in sensitive patients to be less after allo BMT at 34{\%} (range, 8{\%} to 59{\%}) versus 51{\%} (range, 36{\%} to 67{\%}) for the auto patients (HR = 0.51, P = .17). There was a continuing risk of relapse or secondary acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) for 12 years after auto BMT, whereas there were no cases of secondary AML/MDS or relapses beyond 3 years after allo BMT. Conclusion: There seems to be a clinical graft-versus-HL effect associated with allo BMT. Allo BMT for HL also seems to have a lower risk of secondary AML/MDS than auto BMT. Thus, allo BMT warrants continued study in HL.",
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AU - Akpek, G.

AU - Ambinder, Richard F

AU - Piantadosi, S.

AU - Abrams, R. A.

AU - Brodsky, Robert A

AU - Vogelsang, Georgia Boyce

AU - Zahurak, M. L.

AU - Fuller, D.

AU - Miller, C. B.

AU - Noga, S. J.

AU - Fuchs, Ephraim J

AU - Flinn, I. W.

AU - O'Donnell, P.

AU - Seifter, E. J.

AU - Mann, R. B.

AU - Jones, Richard J

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N2 - Purpose: To evaluate the long-term outcome after allogeneic (allo) and autologous (auto) blood or marrow transplantation (BMT) in patients with relapsed or refractory Hodgkin's lymphoma (HL). Patients and Methods: We analyzed the outcome of 157 consecutive patients with relapsed or refractory HL, who underwent BMT between March 1985 and April 1998. Patients ≤ age 55 with HLA-matched siblings were prioritized toward allo BMT. The median age was 28 years (range, 13 to 52 years) for the 53 allo patients and 30.5 years (range, 11 to 62 years) for the 104 auto patients. Results: The median follow-up after BMT for surviving patients was 5.1 years (range, 1 to 13.8 years). For the entire group, the probabilities of event-free survival (EFS) and relapse at 10 years were 26% (95% confidence interval [CI], 18% to 33%) and 58% (95% CI, 48% to 69%), respectively. According to multivariate analysis, disease status before BMT (sensitive relapse if responding to conventional-dose therapy or resistant disease if not) (hazard ratio [HR] = 0.39, P <.0001) and date of BMT (HR = 0.93, P = .004) were independent predictors of EFS, whereas only disease status (HR = 0.35, P <.0001) influenced relapse. There was a trend for probability of relapse in sensitive patients to be less after allo BMT at 34% (range, 8% to 59%) versus 51% (range, 36% to 67%) for the auto patients (HR = 0.51, P = .17). There was a continuing risk of relapse or secondary acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) for 12 years after auto BMT, whereas there were no cases of secondary AML/MDS or relapses beyond 3 years after allo BMT. Conclusion: There seems to be a clinical graft-versus-HL effect associated with allo BMT. Allo BMT for HL also seems to have a lower risk of secondary AML/MDS than auto BMT. Thus, allo BMT warrants continued study in HL.

AB - Purpose: To evaluate the long-term outcome after allogeneic (allo) and autologous (auto) blood or marrow transplantation (BMT) in patients with relapsed or refractory Hodgkin's lymphoma (HL). Patients and Methods: We analyzed the outcome of 157 consecutive patients with relapsed or refractory HL, who underwent BMT between March 1985 and April 1998. Patients ≤ age 55 with HLA-matched siblings were prioritized toward allo BMT. The median age was 28 years (range, 13 to 52 years) for the 53 allo patients and 30.5 years (range, 11 to 62 years) for the 104 auto patients. Results: The median follow-up after BMT for surviving patients was 5.1 years (range, 1 to 13.8 years). For the entire group, the probabilities of event-free survival (EFS) and relapse at 10 years were 26% (95% confidence interval [CI], 18% to 33%) and 58% (95% CI, 48% to 69%), respectively. According to multivariate analysis, disease status before BMT (sensitive relapse if responding to conventional-dose therapy or resistant disease if not) (hazard ratio [HR] = 0.39, P <.0001) and date of BMT (HR = 0.93, P = .004) were independent predictors of EFS, whereas only disease status (HR = 0.35, P <.0001) influenced relapse. There was a trend for probability of relapse in sensitive patients to be less after allo BMT at 34% (range, 8% to 59%) versus 51% (range, 36% to 67%) for the auto patients (HR = 0.51, P = .17). There was a continuing risk of relapse or secondary acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) for 12 years after auto BMT, whereas there were no cases of secondary AML/MDS or relapses beyond 3 years after allo BMT. Conclusion: There seems to be a clinical graft-versus-HL effect associated with allo BMT. Allo BMT for HL also seems to have a lower risk of secondary AML/MDS than auto BMT. Thus, allo BMT warrants continued study in HL.

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