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Outcome after autologous stem cell transplantation in primary refractory or relapsed Hodgkin lymphoma—a long-term follow-up single center experience

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Abstract

Autologous stem cell transplantation (autoSCT) can achieve long-term remission in primary refractory or relapsed Hodgkin lymphoma (r/r HL); however, still up to 50% of patients relapse after autoSCT. In this retrospective analysis, we investigated the impact of autologous stem cell transplantation in a consecutive, unselected cohort of primary refractory and relapsed Hodgkin lymphoma patients (n = 66) with the majority of patients treated in the pre-brentuximab vedotin and immune checkpoint inhibitor era. In our cohort, a 5-year overall survival (OS) from autoSCT of 59.5% and a 5-year progression-free survival (PFS) after autoSCT of 46.1% was achieved. Multivariate analysis revealed primary refractory disease and early relapse (< 12 months) after initial therapy as well as the presence of B symptoms at relapse as independent risk factors associated with a higher risk for relapse and an inferior PFS and OS. Several other clinical factors, including the presence of extranodal disease at relapse and failure to achieve a complete response to salvage chemotherapy, were associated with a trend towards an inferior survival. Patients relapsing after autoSCT had a particularly poor outcome, regardless of eligibility to undergo allogeneic stem cell transplantation (alloSCT). We further evaluated recently published prognostic models for r/r HL patients undergoing autoSCT and could validate several risk scores in our independent “real world” cohort.

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  1. Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany

    Malte Roerden, Martin Sökler, Lothar Kanz, Wolfgang Bethge, Wichard Vogel & Juliane S. Walz

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  1. Malte Roerden
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  2. Martin Sökler
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Correspondence to Malte Roerden.

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Fig. 5

Overall and progression-free survival in subgroups 1. Kaplan-Meier curves regarding overall (OS) and progression-free (PFS) survival in subgroups divided by histology (nodular sclerosis or other, a-b), age (above or under 40 years, c-d) and the presence of extranodal disease at relapse (e-f). Abbreviations: OS overall survival, PFS progression-free survival, NS nodular sclerosis (PNG 990 kb).

High Resolution Image (EPS 230 kb).

Fig. 6

Overall and progression-free survival in subgroups 2. Kaplan-Meier curves regarding overall (OS) and progression-free (PFS) survival in subgroups divided by salvage chemotherapy regimen (a-b), response to salvage chemotherapy (c-d) and LDH level (e-f). Abbreviations: OS overall survival, PFS progression-free survival, LDH lactate dehydrogenase (PNG 868 kb).

High Resolution Image (EPS 240 kb).

Fig. 7

Prognostic score evaluation 2. Kaplan-Meier curves regarding progression-free (PFS) survival of all evaluable patients divided into subgroups according to previously published risk scores (Reece score a-b [23], Josting score c-d [16]). For each score, PFS is shown both for the observation period for which the score was evaluated (a,c) for and the complete follow-up period (b,d) (PNG 610 kb).

High Resolution Image (EPS 156 kb).

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Roerden, M., Sökler, M., Kanz, L. et al. Outcome after autologous stem cell transplantation in primary refractory or relapsed Hodgkin lymphoma—a long-term follow-up single center experience. Ann Hematol 99, 265–276 (2020). https://doi.org/10.1007/s00277-019-03900-x

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