Outcomes for Patients Who Fail High Dose Chemoradiotherapy and Autologous Stem Cell Rescue for Relapsed and Primary Refractory Hodgkin Lymphoma.

Background: Limited data exists regarding the outcome for patients (pts) with relapsed and primary refractory Hodgkin Lymphoma (HL) who fail high dose chemoradiotherapy (HDT) and autologous stem cell rescue (ASCR). The aim of this study is to determine survival time and evaluate the role of second transplantation in pts who have HL-related ASCR failure.

Results: At Memorial Sloan Kettering Cancer Center, from 1995–2005, two hundred and twelve pts with relapsed or primary refractory HL underwent HDT/ASCR after responding to ICE-based salvage chemotherapy on one of four consecutive clinical trials. Eighty-one patients failed HDT, including 10 treatment related mortality (4 deaths within 100 days from ASCR, 5 deaths due to secondary malignancies, and 1 death, 10 years after ASCR due to cardiomyopathy); leaving 71 (33%) pts with biopsy-confirmed progression; median time to progression was 5.7 months. There was 43 males (60%), median age at the time of ASCR was 29 (range 17–65). At a median follow-up of 2 years for surviving patients, the median overall survival from ASCR failure was 25 months. Only seventeen of the 71 pts are currently alive (24%), nine (12.6%) of whom are in remission. Remission duration from ASCR of < 3 months predicted for OS; 1 of 17 pts who relapsed within 3 months are currently alive vs 16 of 54 pts with remission duration of > 3 months; median OS are 13.5 and 27.3 months respectively (p=0.02). Treatment regimens following ASCR failure varied and included gemcitabine-based chemotherapy, MOPP, investigational therapies, radiotherapy and second transplantation. The impact of the various treatment regimens on OS following HL-related ASCR failure was difficult to assess due to the heterogeneity of regimens administered. Treatment with a second transplant had a favorable impact on OS, however only two of 17 pts with remission duration < 3 months were able to receive a second transplant because of rapid disease progression. Twenty-three patients underwent a second transplant of which seven are failure free (1/4 autologous, 6/19 allogeneic). The median OS was 40 months for patients transplanted vs. 19.3 months (p=0.05) for patients ineligible for a second transplant.

Conclusion: Patients who fail HDT/ASCR due to HL progression have a median OS of two years. Relapse within 3 months of ASCR is associated with a poor OS and investigational or novel therapy should be explored in this cohort of pts. An allogeneic transplant following HL-related ASCR failure is associated with a 30% chance of long term survival and should be strongly considered in pts whose remission duration from their initial ASCR is >3 months.