Long-Term Outcomes Among 2-Year Survivors of Autologous Hematopoietic Cell Transplantation for Hodgkin and Diffuse Large B-Cell Lymphoma

• Type of Material: Article
• Authors: Regina Myers, Childrens Hospital of Philadelphia; Brian T. Hill, Cleveland Clinic; Bronwen E. Shaw, Medical College of Wisconsin; Soyoung Kim, Medical College of Wisconsin; Heather R. Millard, Medical College of Wisconsin; Minoo Battiwalla, National Heart, Lung, and Blood Institute; Navneet Majhail, Cleveland Clinic; David Buchbinder, Childrens Hospital of Orange County; Hillard M. Lazarus, Case Western Reserve University; Bipin N. Savani, Vanderbilt University; Mary E.D. Flowers, Fred Hutchinson Cancer Research Center; Anita D'Souza, Medical College of Wisconsin; Matt Ehrhardt, St Jude Childrens Research Hospital; Amelia Langston, Emory University; Jean Yared, University of Maryland; Robert J. Hayashi, Washington University; Andrew Daly, Tom Baker Cancer Clinic; Richard F. Olsson, Karolinska Institutet; Yoshi Inamoto, National Cancer Institute; Adriana K. Malone, Icahn School of Medicine at Mount Sinai; Zachariah DeFilipp, Massachusetts General Hospital; Steven Margossian, Boston Childrens Hospital; Anne Warwick, Uniformed Services University of the Health Sciences; Samantha Jaglowski, Ohio State University; Amer Beitinjaneh, University of Miami; Henry Fung, Fox Chase Cancer Center; Kimberly Kasow, University of North Carolina; David I. Marks, University Hospital Bristol NHS Trust; Jana Reynolds, Baylor University; Keith Stockerl-Goldstein, Washington University; Baldeep Wirk, Seattle Cancer Care Alliance; Wiliam Wood, University of North Carolina; Mehdi Hamadani, Medical College of Wisconsin; Prakash Satwani, Columbia University
• Language: English
• Date: 2018-02-15
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 American Cancer Society
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.31114
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 124
• Issue: 4
• Start Page: 816
• End Page: 825
• Grant/Funding Information: CIBMTR is supported by 5U24-CA076518 from NCI, NHLBI, NIAID and 5U10HL069294 from NHLBI, NCI.
• Keywords: HIGH-DOSE CHEMOTHERAPY; diffuse large B-cell lymphoma; CHILDREN; THERAPY; Hodgkin lymphoma; RELAPSE; autologous hematopoietic cell transplant; BONE-MARROW-TRANSPLANTATION; survival; ADOLESCENTS; MORTALITY; Science & Technology; nonrelapse mortality; late effects; TRIAL; Life Sciences & Biomedicine; Oncology
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: Autologous hematopoietic cell transplantation (auto-HCT) is a standard therapy for relapsed classic Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL); however, long-term outcomes are not well described. METHODS: This study analyzed survival, nonrelapse mortality, late effects, and subsequent malignant neoplasms (SMNs) in 1617 patients who survived progression-free for ≥2 years after auto-HCT for cHL or DLBCL between 1990 and 2008. The median age at auto-HCT was 40 years; the median follow-up was 10.6 years. RESULTS: The 5-year overall survival rate was 90% (95% confidence interval [CI], 87%-92%) for patients with cHL and 89% (95% CI, 87%-91%) for patients with DLBCL. The risk of late mortality in comparison with the general population was 9.6-fold higher for patients with cHL (standardized mortality ratio [SMR], 9.6) and 3.4-fold higher for patients with DLBCL (SMR, 3.4). Relapse accounted for 44% of late deaths. At least 1 late effect was reported for 9% of the patients. A total of 105 SMNs were confirmed: 44 in the cHL group and 61 in the DLBCL group. According to a multivariate analysis, older age, male sex, a Karnofsky score < 90, total body irradiation (TBI) exposure, and a higher number of lines of chemotherapy before auto-HCT were risk factors for overall mortality in cHL. Risk factors in DLBCL were older age and TBI exposure. A subanalysis of 798 adolescent and young adult patients mirrored the outcomes of the overall study population. CONCLUSIONS: Despite generally favorable outcomes, 2-year survivors of auto-HCT for cHL or DLBCL have an excess late-mortality risk in comparison with the general population and experience an assortment of late complications. Cancer 2018;124:816-25. © 2017 American Cancer Society.