Autologous Stem Cell Transplantation for Refractory or Poor-Risk Relapsed Hodgkin%26apos;s Lymphoma: Effect of the Specific High-Dose Chemotherapy Regimen on Outcome

作者：Nieto Yago^*; Popat Uday; Anderlini Paolo; Valdez Ben; Andersson Borje; Liu Ping; Hosing Chitra; Shpall Elizabeth J; Alousi Amin; Kebriaei Partow; Qazilbash Muzaffar; Parmar Simrit; Bashir Qaiser; Shah Nina; Khouri Issa; Rondon Gabriela; Champlin Richard; Jones Roy B

来源：Biology of Blood and Marrow Transplantation, 2013, 19(3): 410-417.

DOI：10.1016/j.bbmt.2012.10.029

• Gemcitabine
• High-dose chemotherapy
• Autologous transplantation
• Refractory
• Hodgkin

More active high-dose chemotherapy (HDC) regimens are needed for refractory Hodgkin%26apos;s lymphoma (HL). We report a cohort analysis of 180 consecutive patients with primary refractory or poor-risk relapsed HL treated with busulfan-melphalan (Bu-Mel) (n = 39), gemcitabine-busulfan-melphalan (Gem-Bu-Mel) (n = 84), or BEAM (BCNU, etoposide, ara-C, melphalan; n = 57) between 2005 and 2010. Their pre-HDC positron emission tomography (PET) scans were interpreted prospectively. Despite more prevalent poor-risk features in the Gem-Bu-Mel cohort, such as PET-positive tumors at HDC, tumors growing at HDC, extranodal disease, or bulky tumors at prior relapse, this cohort had improved outcomes compared with the Bu-Mel and BEAM cohorts, with event-free survival (EFS) rates of 57%, 33%, and 39%, respectively (P = .01), at median follow-up of the whole population of 36 months (range, 3 to 72). Their respective overall survival (OS) rates were, respectively, 82%, 52%, and 59% (P = .04). Secondary acute myelogenous leukemia was seen in 5 patients after BEAM but was not seen in Gem-Bu-Mel and Bu-Mel cohorts (P = .004). Multivariate analyses showed independent adverse effects of an HDC regimen different from Gem-Bu-Mel (hazard ratio [HR] for EFS = 2.3, P = .0008; HR for OS = 2.7, P = .0005), positive PET at HDC (HR for EFS = 2.2, P = .004, HR for OS = 3.1, P = .0001), and %26gt;1 previous salvage line (HR for EFS = 1.9, P = .008, HR for OS = 1.8, P = .07). Gem-Bu-Mel improved outcomes in this cohort analysis of patients with refractory/poor-risk relapsed HL and merits evaluation in randomized phase III trials.

• 出版日期2013-3