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

• 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
• Journal Title: Bone Marrow Transplantation
• Volume: Volume 50, Number 11
• Publisher: Nature Publishing Group | 2015-11-01, Pages 1416-1423
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1038/bmt.2015.177
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Oncology
• Keywords: Life Sciences & Biomedicine; Biophysics; Oncology; Hematology; Immunology; Transplantation; STEM-CELL TRANSPLANTATION; HIGH-DOSE CHEMOTHERAPY; EVENT-FREE SURVIVAL; SALVAGE THERAPY; CONDITIONING REGIMEN; RECURRENT; CYCLOPHOSPHAMIDE

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.