High-dose therapy and stem cell transplant useful for resistant Hodgkin disease

NEW YORK (Reuters Health) - High-dose therapy (HDT) combined with autologous stem cell transplantation (ASCT) may prolong remissions and improve survival in patients with chemoresistant Hodgkin lymphoma, researchers from Seattle report.

Although HDT plus ASCT is standard treatment for chemosensitive relapsed/refractory Hodgkin lymphoma, it is frequently not given to patients with chemoresistant disease, Dr. Ajay K. Gopal, from the University of Washington, and colleagues note. Nonetheless, there are few effective therapies for chemoresistant disease and, therefore, the possibility that HDT plus ASCT may improve outcomes is worth exploring.

The study, reported in the September 15th issue of Cancer, involved 64 patients with resistant Hodgkin lymphoma who were treated with HDT followed by ASCT at the authors' center from 1986 to 2005.

The median age was 35 years and 77% of patients had stage III/IV disease, 80% had a nodular sclerosis histology, and 50% had been treated with radiation in the past.

Forty-one percent of patients received regimens including total body irradiation and the remainder did not receive conditioning, the investigators note.

During a median follow-up period of 4.2 years, the estimated 5-year overall and progression-free survival rates were 31% and 17%, respectively.

On multivariate analysis, the only independent predictor of improved survival was the year of transplant; patients transplanted more recently fared better. For instance, the likelihood of 3-year progression-free survival with treatment in the 1980s was 9%, whereas in the last decade, rates have exceeded 30%.

"Until novel effective therapies are developed, the outcome for individuals with chemoresistant Hodgkin lymphoma will continue to be limited," the authors conclude. Still, the current findings suggest that roughly one in three patients with resistant disease will achieve prolonged remission and survival with HDT plus ASCT.

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