Disease Status Is the Major Prognosis Factor for Allogenic Transplantation Outcome for Hodgkin Lymphoma: a Retrospective Study From the French Society of Bone Marrow Graft Transplantation and Cellular Therapy (SFGM-TC)

The role of allogenic stem cell transplantation (SCT) for the treatment of relapsed/refractory Hodgkin Lymphoma (HL) remains controversial.

we retrospectively analyzed 227 patients who underwent alloSCT between April 1998 and December 2008 for relapsed HL and whose data were reported in the French Society of Marrow Transplantation and Cellular Therapy registry. Thirty-six patients underwent alloSCT with Myeloabaltive Conditioning (MAC) and 191 with Reduced Intensity Conditioning (RIC). Median age was 31 years (13-63 years). Median number of previous therapy regimens was 4. Eighty-nine percent of patients had received a previous Autologous Stem Cell Transplantation (ASCT).

Median follow up was 36 months (2-103 months). The 1-year cumulative incidence of non-relapse mortality (NRM) was 17%. Estimated 3 years Overall Survival (OS), Progression free Survival (PFS) and cumulative incidence of relapse (CIR) were 55%, 36%, 47%, respectively for the entire cohort. In multivariate analysis, there was no difference in outcome between patients in CR and PR at time of transplantation for OS (67% vs 68% at 3 years) and PFS (50% vs 40% at 3 years, p=ns). However, patients with chemoresistant disease (stable or progressive) at time of transplantation had a significantly shorter PFS (13% at 3 years p<0.0001) and OS (30% at 3 years p<0.0001) than patients with chemosensitive disease (CR and PR). Moreover, patients with chemoresistant disease have a higher CIR and NRM compared to patients with chemosensitive disease: 62% versus 40% (p<0.0001) and 28% versus 13% (p=0.015) at 3 years. Interestingly, in multivariate analysis for OS, previous ASCT occurring less than 3 months before allogenic stem cell transplantation was found to be associated with better outcome (HR=0.51 (0.27 to 0.99, 95% CI), p=0.046). Use of cord blood was associated with poor outcome (HR =2.74 (1.12 to 6.71, 95%CI), p=0.027). However, there was no impact of chronic Graft-versus-host disease (cGVHD) on outcome when cGVHD was studied as a time-dependent covariate.

This study shows that Allogenic SCT especially following reduced intensity conditioning is a feasible option for relapsed HL. Disease status at transplantation remains the major risk factor for outcome. In addition our data suggest that allogenic SCT should be performed as early as possible after ASCT.

No relevant conflicts of interest to declare.