High Dose Therapy with Autologous Stem Cell Transplantation in Patients
with Hodgkin’s Lymphoma: Long Term Follow-up in Patients Treated in One Center
1Trněný M., 1Vacková B., 1Pytlík R., 1Cieslar P., 1,2Válková V., 2Gašová Z., 2Kobylka P., 1Trnková M., 1Krejčová H., 1,2Klener P.
1I. interní klinika 1. LF UK a VFN, Praha 2Ústav hematologie a krevní transfuze, Praha |
|
Summary:
Backround. Majority of patients with Hodgkin’s Lymphoma (HL) can be cured by first line therapy. The high dose
therapy (HDT) with autologous stem cell transplantation (ASCT) is the option which can be used in the situation
when the conventional therapy failed.
Methods and Results. Beginning 1994 till 2005 84 pts with HL who did not respond the conventional chemotherapy
underwent 105 HDT procedures with ASCT. The median age at the time of HDT was 30.5 years. The reason for
salvage therapy followed by HDT with ASCT was the failure to achieve 1st complete remission - CR (n 16) or the
subsequent relapse or progression (n 68). The disease status at the time of HDT after conventional salvage chemotherapy
was assessed as chemosensitive in 65 pts (77.4 %) and chemoresistant in 19 pts (22.6 %). The most frequent
HDT regimen used was BEAM (82 HDT), 22 pts entered into the tandem HDT program. Bone marrow only was used
as the source of progenitor cells in 4 ASCT, peripheral blood progenitor cells (PBPC) only were used in 85 ASCT
and the combination of both in 16 ASCT. The disease status after the HDT with ASCT was assessed (77 pts were qualifiable)
as CR in 39 pts (50.6 %), PR in 31 (40.3%) and as stable disease or progression in 7 pts (9.1 %). Treatment
related mortality in HDT with PBPC was 3.9 %. The median follow up is 5.3 years. The five year probability of event
free survival (EFS) is 43.1 % and overall survival 53.2 %. The EFS and OS probability respectively for the chemosensitive
patients was 48.6 % and 62.9 % respectively. The status at HDT and the results after it have prognostic significance.
There were observed 39 deaths and 26 of them were caused by disease progression. Secondary tumor was
observed in 5 pts and in all of them it caused the death.
Conclusions. The HDT with ASCT allows the long term survival without disease progression in about a half of the
patients with reasonable toxicity.
Key words:
Hodgkin’s Lymphoma, transplantation, high dose therapy.
|