Outcome and prognostic factors in advanced Hodgkin's disease treated with high-dose chemotherapy and autologous stem cell transplantation: a study of 341 patients

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BackgroundThe reported probability of survival of patients with Hodgkin's disease (HD) following high-dose chemotherapy with autologous stem cell transplantation (HDC/ASCT) is 35–65% at 5 years. The Polish Lymphoma Research Group investigated retrospectively prognostic factors for overall survival (OS) and event-free survival (EFS), and the risk of secondary malignancies in a large series of patients who underwent HDC/ASCT.Patients and methodsThe data of 341 consecutive patients treated in 10 centers from 1990 to 2002 were collected and analyzed.ResultsThe actuarial 5-year OS and EFS were 64% [95% confidence interval (CI) 57% to 71%] and 45% (95% CI 39% to 51%), respectively. In the multivariate model, unfavorable prognostic factors for EFS were less than partial response at the time of ASCT [relative risk (RR), 2.92 (95% CI 1.68–5.08); P<0.001] and three or more previous chemotherapy lines (RR, 2.16; 95% CI 1.42–3.30; P<0.001). These two factors were also associated with unfavorable OS (RR, 3.32; 95% CI 1.90–5.79; P<0.001 and RR, 2.34, 95% CI 1.51–3.64; P<0.001). Five-year cumulative risk of secondary malignancy was 8.4% (95% CI 2% to 13%) and the only identified risk factor was splenectomy (P=0.02).ConclusionsHDC/ASCT should be considered early in the course of disease for patients with a response after standard therapy.

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