A prognostic model predicting autologous transplantation outcomes in children, adolescents and young adults with Hodgkin lymphoma

• Type of Material: Article
• Authors: Prakash Satwani, Columbia University; Kwang Woo Ahn, Medical College of Wisconsin; Jeanette Carreras, Medical College of Wisconsin; Hisham Abdel-Azim, University of Southern California; Mitchell S. Cairo, New York Medical College; Amanda Cashen, Washington University in St. Louis; Andy I. Chen, Oregon Health and Science University; Jonathon Cohen, Emory University; Luciano J. Costa, University of Alabama at Birmingham; Christopher Dandoy, Cincinnati Children’s Hospital Medical Center; Timothy S. Fenske, Medical College of Wisconsin; César O. Freytes, South Texas Veterans Health Care System; Siddhartha Ganguly, University of Kansas; Robert Peter Gale, Imperial College London; Nilanjan Ghosh, Carolinas Healthcare System; Mark S. Hertzberg, Prince of Wales Hospital; Robert J. Hayashi, Washington University in St. Louis; Rummurti T. Kamble, Baylor College of Medicine; Abraham S. Kanate, West Virginia University; Armand Keating, University of Toronto; Mohamed A. Kharfan-Dabaja, University of South Florida; Hillard M. Lazarus, University Hospitals Case Medical Center; David I. Marks, University Hospitals Bristol NHS Trust; Taiga Nishihori, University of South Florida; Richard F. Olsson, Karolinska Institutet; Tim D. Prestidge, Starship Children’s Hospital; Juliana Martinez Rolon, FUNDALEU; Bipin N. Savani, Vanderbilt University; Julie M. Vose, Nebraska Medical Center; William A. Wood, University of North Carolina; David J. Inwards, Mayo Clinic; Veronika Bachanova, University of Minnesota; Sonali M. Smith, University of Chicago; David G. Maloney, Fred Hutchinson Cancer Research Center; Anna Sureda, Hospital Duran i Reynals, Spain; Mehdi Hamadani, Medical College of Wisconsin
• Language: English
• Date: 2015-11-01
• Publisher: Nature Publishing Group
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Macmillan Publishers Limited. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1038/bmt.2015.177
• Title of Journal or Parent Work: Bone Marrow Transplantation
• ISSN: 0268-3369
• Volume: 50
• Issue: 11
• Start Page: 1416
• End Page: 1423
• Grant/Funding Information: For the full list of donors, see Acknowledgments in the full article.; The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-12-1-0142 and N00014-13-1-0039 from the Office of Naval Research.
• Keywords: RECURRENT; EVENT-FREE SURVIVAL; Biophysics; CONDITIONING REGIMEN; SALVAGE THERAPY; Life Sciences & Biomedicine; CYCLOPHOSPHAMIDE; Hematology; STEM-CELL TRANSPLANTATION; Transplantation; HIGH-DOSE CHEMOTHERAPY; Oncology; Immunology
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Autologous hematopoietic cell transplantation (AutoHCT) is a potentially curative treatment modality for relapsed/refractory Hodgkin lymphoma (HL). However, no large studies have evaluated pretransplant factors predictive of outcomes of AutoHCT in children, adolescents and young adults (CAYA, age <30 years). In a retrospective study, we analyzed 606 CAYA patients (median age 23 years) with relapsed/refractory HL who underwent AutoHCT between 1995 and 2010. The probabilities of PFS at 1, 5 and 10 years were 66% (95% confidence interval (CI): 62-70), 52% (95% CI: 48-57) and 47% (95% CI: 42-51), respectively. Multivariate analysis for PFS demonstrated that at the time of AutoHCT patients with Karnofsky/Lansky score ≥90, no extranodal involvement and chemosensitive disease had significantly improved PFS. Patients with time from diagnosis to first relapse of <1 year had a significantly inferior PFS. A prognostic model for PFS was developed that stratified patients into low-, intermediate- and high-risk groups, predicting for 5-year PFS probabilities of 72% (95% CI: 64-80), 53% (95% CI: 47-59) and 23% (95% CI: 9-36), respectively. This large study identifies a group of CAYA patients with relapsed/refractory HL who are at high risk of progression after AutoHCT. Such patients should be targeted for novel therapeutic and/or maintenance approaches post-AutoHCT.