Autotransplants for Hodgkin's disease in patients never achieving remission

A report from the autologous blood and marrow transplant registry

Hillard M. Lazarus, Philip A. Rowlings, Mei Jie Zhang, Julie Marie Vose, James Olen Armitage, Philip Jay Bierman, James L. Gajewski, Robert Peter Gale, Armand Keating, John P. Klein, Carole B. Miller, Gordon L. Phillips, Donna E. Reece, Kathleen A. Sobocinski, Koen Van Besien, Mary M. Horowitz

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Abstract

Purpose: Hodgkin's disease patients who never achieve complete remission with conventional chemotherapy (ie, those with primary induction failure) have a poor prognosis. Some subjects who receive high-dose therapy with autologous hematopoietic progenitor-cell infusion experience prolonged progression-free survival. Patients and Methods: Detailed records from the Autologous Blood and Marrow Transplant Registry (ABMTR) on 122 Hodgkin's disease patients who failed to achieve complete remission after one or more conventional therapy regimens and subsequently received an autotransplant between 1989 and 1995 were reviewed. Results: Median age was 27 years (range, 7 to 57 years). Median time from diagnosis to transplantation was 14 months (range, 5 to 38 months). Most patients received high-dose chemotherapy without radiation for pretransplantation conditioning (n = 107). The regimen most frequently used was cyclophosphamide, carmustine, and etoposide (n = 47). Fifteen patients received total-body irradiation (n = 15). The graft consisted of bone marrow (n = 86), blood stem cells (n = 25), or both (n = 11). The 100-day mortality was 12% (95% confidence interval, 7% to 19%). Sixty patients (50%) were considered to have achieved complete remission after autotransplantation; 37 of these had negative imaging studies, whereas scan abnormalities of unknown significance persisted in 23 patients. Twenty- seven patients (22%) had no response or progressive disease after transplantation. Probabilities of progression-free and overall survival at 3 years were 38% (95% confidence interval, 28% to 48%) and 50% (95% confidence interval, 39% to 60%), respectively. In multivariate analysis, 'B' symptoms at diagnosis and poor performance score at transplantation were adverse prognostic factors for outcome. Conclusion: Autotransplants should be considered for patients with Hodgkin's disease who do not achieve complete remission with conventional therapy.

Original languageEnglish (US)
Pages (from-to)534-545
Number of pages12
JournalJournal of Clinical Oncology
Volume17
Issue number2
StatePublished - Feb 1 1999

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Autografts
Hodgkin Disease
Registries
Bone Marrow
Transplants
Transplantation
Confidence Intervals
Disease-Free Survival
Drug Therapy
Carmustine
Autologous Transplantation
Whole-Body Irradiation
Etoposide
Hematopoietic Stem Cells
Cyclophosphamide
Blood Cells
Stem Cells
Therapeutics
Multivariate Analysis
Radiation

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Autotransplants for Hodgkin's disease in patients never achieving remission : A report from the autologous blood and marrow transplant registry. / Lazarus, Hillard M.; Rowlings, Philip A.; Zhang, Mei Jie; Vose, Julie Marie; Armitage, James Olen; Bierman, Philip Jay; Gajewski, James L.; Gale, Robert Peter; Keating, Armand; Klein, John P.; Miller, Carole B.; Phillips, Gordon L.; Reece, Donna E.; Sobocinski, Kathleen A.; Van Besien, Koen; Horowitz, Mary M.

In: Journal of Clinical Oncology, Vol. 17, No. 2, 01.02.1999, p. 534-545.

Research output: Contribution to journalArticle

Lazarus, HM, Rowlings, PA, Zhang, MJ, Vose, JM, Armitage, JO, Bierman, PJ, Gajewski, JL, Gale, RP, Keating, A, Klein, JP, Miller, CB, Phillips, GL, Reece, DE, Sobocinski, KA, Van Besien, K & Horowitz, MM 1999, 'Autotransplants for Hodgkin's disease in patients never achieving remission: A report from the autologous blood and marrow transplant registry', Journal of Clinical Oncology, vol. 17, no. 2, pp. 534-545.
Lazarus, Hillard M. ; Rowlings, Philip A. ; Zhang, Mei Jie ; Vose, Julie Marie ; Armitage, James Olen ; Bierman, Philip Jay ; Gajewski, James L. ; Gale, Robert Peter ; Keating, Armand ; Klein, John P. ; Miller, Carole B. ; Phillips, Gordon L. ; Reece, Donna E. ; Sobocinski, Kathleen A. ; Van Besien, Koen ; Horowitz, Mary M. / Autotransplants for Hodgkin's disease in patients never achieving remission : A report from the autologous blood and marrow transplant registry. In: Journal of Clinical Oncology. 1999 ; Vol. 17, No. 2. pp. 534-545.
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abstract = "Purpose: Hodgkin's disease patients who never achieve complete remission with conventional chemotherapy (ie, those with primary induction failure) have a poor prognosis. Some subjects who receive high-dose therapy with autologous hematopoietic progenitor-cell infusion experience prolonged progression-free survival. Patients and Methods: Detailed records from the Autologous Blood and Marrow Transplant Registry (ABMTR) on 122 Hodgkin's disease patients who failed to achieve complete remission after one or more conventional therapy regimens and subsequently received an autotransplant between 1989 and 1995 were reviewed. Results: Median age was 27 years (range, 7 to 57 years). Median time from diagnosis to transplantation was 14 months (range, 5 to 38 months). Most patients received high-dose chemotherapy without radiation for pretransplantation conditioning (n = 107). The regimen most frequently used was cyclophosphamide, carmustine, and etoposide (n = 47). Fifteen patients received total-body irradiation (n = 15). The graft consisted of bone marrow (n = 86), blood stem cells (n = 25), or both (n = 11). The 100-day mortality was 12{\%} (95{\%} confidence interval, 7{\%} to 19{\%}). Sixty patients (50{\%}) were considered to have achieved complete remission after autotransplantation; 37 of these had negative imaging studies, whereas scan abnormalities of unknown significance persisted in 23 patients. Twenty- seven patients (22{\%}) had no response or progressive disease after transplantation. Probabilities of progression-free and overall survival at 3 years were 38{\%} (95{\%} confidence interval, 28{\%} to 48{\%}) and 50{\%} (95{\%} confidence interval, 39{\%} to 60{\%}), respectively. In multivariate analysis, 'B' symptoms at diagnosis and poor performance score at transplantation were adverse prognostic factors for outcome. Conclusion: Autotransplants should be considered for patients with Hodgkin's disease who do not achieve complete remission with conventional therapy.",
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T2 - A report from the autologous blood and marrow transplant registry

AU - Lazarus, Hillard M.

AU - Rowlings, Philip A.

AU - Zhang, Mei Jie

AU - Vose, Julie Marie

AU - Armitage, James Olen

AU - Bierman, Philip Jay

AU - Gajewski, James L.

AU - Gale, Robert Peter

AU - Keating, Armand

AU - Klein, John P.

AU - Miller, Carole B.

AU - Phillips, Gordon L.

AU - Reece, Donna E.

AU - Sobocinski, Kathleen A.

AU - Van Besien, Koen

AU - Horowitz, Mary M.

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N2 - Purpose: Hodgkin's disease patients who never achieve complete remission with conventional chemotherapy (ie, those with primary induction failure) have a poor prognosis. Some subjects who receive high-dose therapy with autologous hematopoietic progenitor-cell infusion experience prolonged progression-free survival. Patients and Methods: Detailed records from the Autologous Blood and Marrow Transplant Registry (ABMTR) on 122 Hodgkin's disease patients who failed to achieve complete remission after one or more conventional therapy regimens and subsequently received an autotransplant between 1989 and 1995 were reviewed. Results: Median age was 27 years (range, 7 to 57 years). Median time from diagnosis to transplantation was 14 months (range, 5 to 38 months). Most patients received high-dose chemotherapy without radiation for pretransplantation conditioning (n = 107). The regimen most frequently used was cyclophosphamide, carmustine, and etoposide (n = 47). Fifteen patients received total-body irradiation (n = 15). The graft consisted of bone marrow (n = 86), blood stem cells (n = 25), or both (n = 11). The 100-day mortality was 12% (95% confidence interval, 7% to 19%). Sixty patients (50%) were considered to have achieved complete remission after autotransplantation; 37 of these had negative imaging studies, whereas scan abnormalities of unknown significance persisted in 23 patients. Twenty- seven patients (22%) had no response or progressive disease after transplantation. Probabilities of progression-free and overall survival at 3 years were 38% (95% confidence interval, 28% to 48%) and 50% (95% confidence interval, 39% to 60%), respectively. In multivariate analysis, 'B' symptoms at diagnosis and poor performance score at transplantation were adverse prognostic factors for outcome. Conclusion: Autotransplants should be considered for patients with Hodgkin's disease who do not achieve complete remission with conventional therapy.

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