A prognostic model predicting autologous transplantation outcomes in children, adolescents and young adults with Hodgkin lymphoma

• Published in: Bone marrow transplantation (Basingstoke) Vol. 50; no. 11; pp. 1416 - 1423
• Main Authors: Satwani, P, Ahn, K W, Carreras, J, Abdel-Azim, H, Cairo, M S, Cashen, A, Chen, A I, Cohen, J B, Costa, L J, Dandoy, C, Fenske, T S, Freytes, C O, Ganguly, S, Gale, R P, Ghosh, N, Hertzberg, M S, Hayashi, R J, Kamble, R T, Kanate, A S, Keating, A, Kharfan-Dabaja, M A, Lazarus, H M, Marks, D I, Nishihori, T, Olsson, R F, Prestidge, T D, Rolon, J M, Savani, B N, Vose, J M, Wood, W A, Inwards, D J, Bachanova, V, Smith, S M, Maloney, D G, Sureda, A, Hamadani, M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.11.2015; Nature Publishing Group
• Subjects: 631/67/70; 692/699/1541/1990/291/1556; Adolescent; Adolescents; Adult; Adults; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Autografts; Bone marrow; Care and treatment; Cause of Death; Cell Biology; Child; Child, Preschool; Children; Combined Modality Therapy; Confidence intervals; Disease age factors; Disease Progression; Disease-Free Survival; Female; Follow-Up Studies; Hematology; Hematopoietic Stem Cell Transplantation; Hodgkin Disease - drug therapy; Hodgkin Disease - mortality; Hodgkin Disease - radiotherapy; Hodgkin Disease - therapy; Hodgkin's disease; Hodgkin's lymphoma; Humans; Internal Medicine; Lymphoma; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Methods; Models, Theoretical; Multivariate analysis; Neoplasms, Second Primary - epidemiology; original-article; Patient outcomes; Patients; Prognosis; Proportional Hazards Models; Public Health; Retrospective Studies; Risk groups; Salvage Therapy; Stem cell research; Stem cell transplantation; Stem Cells; Transplantation; Transplantation, Autologous; Young Adult; Young adults
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/bmt.2015.177

Autologous hematopoietic cell transplantation (AutoHCT) is a potentially curative treatment modality for relapsed/refractory Hodgkin lymphoma (HL). However, no large studies have evaluated pretransplant factors predictive of outcomes of AutoHCT in children, adolescents and young adults (CAYA, age <30 years). In a retrospective study, we analyzed 606 CAYA patients (median age 23 years) with relapsed/refractory HL who underwent AutoHCT between 1995 and 2010. The probabilities of PFS at 1, 5 and 10 years were 66% (95% confidence interval (CI): 62–70), 52% (95% CI: 48–57) and 47% (95% CI: 42–51), respectively. Multivariate analysis for PFS demonstrated that at the time of AutoHCT patients with Karnofsky/Lansky score ⩾90, no extranodal involvement and chemosensitive disease had significantly improved PFS. Patients with time from diagnosis to first relapse of <1 year had a significantly inferior PFS. A prognostic model for PFS was developed that stratified patients into low-, intermediate- and high-risk groups, predicting for 5-year PFS probabilities of 72% (95% CI: 64–80), 53% (95% CI: 47–59) and 23% (95% CI: 9–36), respectively. This large study identifies a group of CAYA patients with relapsed/refractory HL who are at high risk of progression after AutoHCT. Such patients should be targeted for novel therapeutic and/or maintenance approaches post-AutoHCT.