Abstract 6034
Background
High dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) is currently the treatment of choice for refractory or relapsed Hodgkin’s lymphoma (HL) and cures up to 50% of patients. However, its applicability is restricted to selected eligible patients and/or responding to salvage chemotherapy. The aim was to compare outcomes after salvage regimens with and without HDT and ASCT in HL patients who failed or relapsed after ABVD or BEACOPP regimens.
Methods
From 856 patients with newly diagnosed HL registered in the MRRC database between 1998 and 2017 there were identified 131 patients with refractory disease (gr.1, n = 89), early (gr. 2, n = 31) or late (gr.3, n = 11) relapse. At first relapse, patients had median age 30 years (range, 17 to 69); male, 46%; stage III/IV, 70%; B symptoms, 28%. Of 131 patients, 76 (58%) received standard CT regimens (ST) when HDT was not available (n = 64) or contraindicated (12). HDT was initiated in 55 (42%) patients, but withdrawn in 38 of them (adverse effects, 9; progression, 24; low cytopheresis, 5). ASCT was performed in 17 (31%) patients.
Results
Median follow-up time after first failure for survived patients (79 of 131, 60%) was 60 months (8-186). Durable second remissions were achieved in 10 (59%) of 17 patients after ASCT and in 30 (40%) of 76 patients after ST. In an intention-to-treat (ITT) analysis median freedom from second failure (FF2F) after HDT and ST was, respectively, 4 vs. 15 months in Gr.1 (p = 0.018) but did not differ (15 and 16 months) in Gr.2; Gr.3 was too small for ITT. Median overall survival (OS2) after HDT and ST was, respectively, 22 vs. 158 months in Gr.1 (p = 0.036) and 42 vs. 52 months in Gr.2 (n.s).
Conclusions
This single center analysis demonstrates the effectiveness of standard CT regimens as first-line salvage in patients not eligible for HDT/ASCT. It also demonstrates the high failure rate due to inadequate chemo-responsiveness at salvage in patients referred to HDT: An effect not accounted for in studies analyzing only outcome following HDT/ASCT.
Clinical trial identification
Legal entity responsible for the study
Viacheslav Vladimirovich.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.