☆ 4.7 Article

Chemoresistance can be overcome with high-dose chemotherapy and autologous stem-cell transplantation for relapsed and refractory Hodgkin lymphomaaEuro

ANNALS OF ONCOLOGY (2014)

Journal

ANNALS OF ONCOLOGY

Volume 25, Issue 11, Pages 2218-2223

Publisher

OXFORD UNIV PRESS

DOI: 10.1093/annonc/mdu387

Keywords

Hodgkin lymphoma; chemoresistance; stem-cell transplant; therapy; relapsed; refractory

Funding

Seattle Genetics

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Abstract

Resistance to secondary chemotherapy can be overcome with high-dose therapy and autologous stem-cell transplant (HDT/ASCT), resulting in cure in 30%-50% of patients. HDT/ASCT should therefore be considered in all transplant eligible patients, regardless of responsiveness to secondary chemotherapy .High-dose therapy and autologous stem-cell transplant (HDT/ASCT) is the preferred treatment of chemosensitive relapsed/refractory Hodgkin lymphoma (HL). The role for HDT/ASCT in chemoresistant HL is less well defined. We evaluated long-term outcomes of relapsed/refractory HL patients whose disease was refractory to secondary chemotherapy preceding HDT/ASCT. All HL patients who underwent HDT/ASCT in British Columbia for primary progression (PP, defined as progression within 3 months of initial therapy completion) or first relapse (REL1) were reviewed. Patients were grouped based on response to secondary chemotherapy as sensitive (S), resistant (R), and untested/unknown (U). A total of 256 patients underwent HDT/ASCT for PP (35%) or REL1 (65%) between 1985 and 2011. At median follow-up of 11.7 years, 58% were alive without HL, 36% relapsed; 6% died of transplant-related mortality, 3% secondary malignancies, and 3% unrelated causes. For PP/S, PP/R, and PP/U groups, 10-year FFS were 47%, 31%, and 38%; 10-year OS were 52%, 29%, and 37%, respectively. For REL1/S, REL1/R, and REL1/U groups, 10-year FFS were 64%, 51%, and 81%; 10-year OS were 71%, 59%, and 79%, respectively. In multivariate analysis, resistance to secondary chemotherapy predicted for post-transplant mortality in the PP (P = 0.04) but not REL1 (P = 0.16) groups. In this large uniformly treated cohort of HL patients with long-term follow-up, chemoresistance preceding HDT/ASCT was identified as a poor prognostic factor; however, this factor can be partially overcome by HDT/ASCT, resulting in cure in 30%-50% of patients. HDT/ASCT should therefore be considered in all transplant eligible patients, regardless of responsiveness to salvage chemotherapy.

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Autologous stem cell transplantation after anti-PD-1 therapy for multiply relapsed or refractory Hodgkin lymphoma

Reid W. Merryman, Robert A. Redd, Taiga Nishihori, Julio Chavez, Yago Nieto, Justin M. Darrah, Uttam Rao, Michael T. Byrne, David A. Bond, Kami J. Maddocks, Michael A. Spinner, Ranjana H. Advani, Hatcher J. Ballard, Jakub Svoboda, Anurag K. Singh, Joseph P. McGuirk, Dipenkumar Modi, Radhakrishnan Ramchandren, Jason Romancik, Jonathon B. Cohen, Matthew J. Frigault, Yi-Bin Chen, Anthony Serritella, Justine Kline, Stephen Ansell, Sunita Nathan, Maryam Rahimian, Robin M. Joyce, Mansi Shah, Kevin A. David, Steven Park, Anne W. Beaven, Alma Habib, Veronika Bachanova, Shazia Nakhoda, Nadia Khan, Ryan C. Lynch, Stephen D. Smith, Vincent T. Ho, Ann LaCasce, Philippe Armand, Alex F. Herrera

Summary: Autologous stem cell transplantation (ASCT) following anti-PD-1 therapy shows promising outcomes for relapsed/refractory Hodgkin lymphoma (HL) patients, even in high-risk cases, with favorable survival rates observed.

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