SALVAGE CHEMOTHERAPY FOLLOWED BY AUTOLOGOUS STEM CELL TRANSPLANTATION MAY BE CURATIVE IN 50% OF RELAPSED OR REFRACTORY CLASSICAL HODGKIN LYMPHOMA: A SINGLE-CENTER EXPERIENCE

Abstract

Cilj ovog rada bio je prikazati rezultate liječenja bolesnika s relapsnim ili refraktornim klasičnim Hodgkinovim limfomom visokodoznom kemoterapijom praćenom autolognom transplantacijom matičnih stanica u jednoj ustanovi. U retrospektivno istraživanje uključen je 101 bolesnik liječen u razdoblju od 1995. do 2014. godine. Svi su bolesnici primili mijeloablativni protokol BEAM. Ukupna stopa odgovora bila je 92,1 %, medijan praćenja je iznosio 42 mjeseca. Petogodišnje ukupno preživljenje je iznosilo 56 %, a preživljenje bez progresije bolesti 51 %. U svakom ishodu postignut je plato bez daljnjih događaja pokazajući liječidbenu mogućnost ovog pristupa za oko 50 % bolesnika. Prognostički čimbenici povezani s kraćim ukupnim preživljenjem bili su prisutnost B simptoma i anemije u relapsu, odnosno nepostizanje kompletne remisije na visokodoznu terapiju. Bolesnici, koji nisu postignuli drugu kompletnu remisiju, imali su kraće ukupno preživljenje s postignutim platoom u oko 40 % bolesnika što pokazuje mogućnost autologne transplantacije da donekle umanji kemorefraktornu bolest kao negativan prognostički čimbenik. Neuspjeh postizanja druge kompletne remisije bio je jedini čimbenik povezan s kraćim preživljenjem bez progresije bolesti. Bolesnici koji nisu postignuli kompletnu remisiju na autolognu transplantaciju ili su imali drugi relaps bolesti imali su lošije petogodišnje ukupno preživljenje u iznosu od 31% i 16 %. Prema našim rezultatima te, sukladno literaturnom pregledu, pokazali smo da je visokodozna terapija praćena autolognom transplantacijom matičnih stanica optimalan pristup ovim bolesnicima.The main aim of this study was to present outcomes and prognostic factors in relapsed and refractory classical Hodgkin lymphoma undergoing salvage chemotherapy followed by stem cell transplantation. This retrospective study included 101 adult patients being treated at a single center in the period between 1995-2014. The most commonly used salvage chemotherapy was miniBEAM. All patients received BEAM myeloablative protocol followed by stem cell reinfusion. The ORR was 92.1%. After a median of follow-up of 42 months, 5-year OS rate was 56% with 5-year PFS rate being 51%. In each survival curve, a plateau was achieved implying the curative possibility of autologous stem cell transplantation. Adverse prognostic factors associated with worse OS were presence of B symptoms and anemia at relapse and chemoresistance to salvage chemotherapy, defi ned as inability to achieve 2nd complete remission. However, in survival curve a plateau was reached indicating that 40% of chemorefractory patients can be cured with this approach. Only prognostic factor associated with inferior PFS was chemoresistance to salvage therapy. Outcomes for patients not responding to or relapsing after stem cell transplantation were less advantageous with 31% and 16% 5-years OS rates, stressing the need for better clinical approach in this subpopulation. Based on our results and according to the literature review, we demonstrate that salvage therapy followed by autologous stem cell transplantation represents a treatment of choice in transplant-eligible patients suffering from relapsed or refractory Hodgkin lymphoma