Autologous Hematopoietic Stem Cell Transplantation Following a Uniform Modified BEAM Conditioning Regimen for Hodgkin's Lymphoma – Prognostic Factors and Long-Term Outcomes.

Abstract 3406

Poster Board III-294

Autologous hematopoietic stem cell transplantation (autoHCT) is considered the treatment of choice for patients (pts) with relapsed Hodgkin's lymphoma (HL) and the treatment option for pts who did not adequately respond to conventional therapy. We retrospectively evaluated prognostic factors affecting the long-term outcome of 131 pts, median age 29 (16-59) years with advanced HL (stage IIB-IVB) treated with autoHCT following modified BEAM regimen (BCNU 300mg/m2, etoposid 800mg/m2, cytarabine 6000mg/m2, melphalan 140mg/m2 and dexamethasone 168mg/m2) between 1992 and 2007 in our department Twelve pts were treated with planned tandem autoHCT and received different regimen before second transplant. The indications for autoHCT were: inadequate response to conventional therapy defined as less then complete remission after first line chemotherapy (71 pts), relapse (52 pts) and progressive disease (8 pts). The patients were treated with the median 2.5 (range 1-4) chemotherapy lines before autoHCT. The disease status at transplant was: complete remission (47 pts), partial remission (73 pts) and less then PR (11 pts). The source of progenitor cells was bone marrow (46 pts), peripheral blood (76 pts) and bone marrow plus peripheral blood (9 pts). The median follow-up of the living patients was 65 (12-196) months. OS was 81% (95% CI 61-100), 52% (95% CI 26-78) and 43% (95% CI 6-84) at 7 years for patients transplanted due to inadequate response to conventional therapy, relapse and progressive disease respectively estimated with the Kaplan-Meier method. The 7-yrs DFS was 66% (95% CI 42-90), 56% (95% CI 5-67) and 50% (95% CI 15-84) for the same groups of pts respectively. There were 8/143 (5,6 %) early deaths due to infection (7 pts) and primary graft failure (1 patient). The secondary malignancies developed in 5 pts, including 3 cases of MDS/AML, 1 case of NHL and one solid tumor. The 10-year cumulative incidence of secondary malignancies was 9%. In univariate analysis, prognostic factors associated with decreased DFS and OS of the pts transplanted due to relapse were the disease status at transplantation (less then PR vs CR/PR, p 0.01) and the duration of initial remission (< 12 months vs > 12 months, p 0.01 for OS and p 0.003 for DFS). In multivariate analysis, the disease status at autoHCT remained statistically significant (HR 1.69, p 0.05) for OS and the duration of initial remission (HR 8.9, p 0.04) for DFS. DFS of pts transplanted due to inadequate response to conventional therapy or progressive disease was adversely affected by the number of prior chemotherapy lines (>2 vs 1-2 lines, HR 6.0, p 0.05). We conclude that high proportion of patients with advanced HL who did not adequately respond to conventional treatment can be cured with autoHCT following modified BEAM regimen performed early in the course of the disease. The outcome of pts with relapsed disease depends on the response to the salvage therapy. The results of autoHCT in chemoresistant relapse are not satisfactory.