Three factors predicted event-free (relapse-free) survival after autologous stem cell transplantation in adults with refractory Hodgkin’s Lymphoma (HL):
- extra nodal sites of disease (disease affecting organs other than lymph nodes)
- complete response of less than 1-year duration or primary refractory disease, and
- B symptoms (fever, night sweats, weight loss)
For patients with zero or one factor, the 5-year event-free and overall survivals were 83% and 90%, respectively. If two factors were present, the 5-year event-free and overall survivals were 27% and 57%, respectively; if all factors were present, this decreased to 10% and 25%, respectively.
In a study conducted by Stanford University, B symptoms, stage IV disease involving the bone marrow or lung, and greater-than-minimal residual disease at the time of presentation for transplantation were associated with a poor prognosis.
The most important clinical factor for long-term survival after stem cell transplantation is duration of prior complete response. The 5-year survival of patients with a complete response to chemotherapy lasting greater than 12 months was 63%; this was statistically more significant higher than the 5-year survival in patients had a complete remission of less than 12 months (44%).
Chemosensitivity of the disease (how well it responds to chemotherapy prior to transplantation) in patients who were found to have documented refractory HL on bone marrow biopsy. The overall survival for patients with chemosensitive disease at 10 years was 66% compared with 17% for those with chemoresistant disease.
In conclusion, autologous transplantation for HL has been shown to improve progression-free survival, but not overall survival. Patients with chemosensitive disease before transplantation have more promising outcomes. The time between complete response to therapy and relapse is an important factor in determining the prognosis for transplant success: a long disease-free interval indicates improved survival.
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