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Lymphoma

Progressive disease following autologous transplantation in patients with chemosensitive relapsed or primary refractory Hodgkin's disease or aggressive non-Hodgkin's lymphoma

Bone Marrow Transplantation volume 32, pages 673–679 (2003)Cite this article

Summary:

To determine the outcome of patients with chemosensitive relapsed or primary refractory Hodgkin's disease (HD) or aggressive non-Hodgkin's lymphoma (NHL) whose disease progresses after autologous stem cell transplantation (ASCT), we reviewed the records of 82 patients with HD and 139 patients with NHL transplanted between 1993 and 2000. Disease progression occurred in 25 patients with HD and 66 patients with NHL, with median times to progression (TTP) of 3.8 and 5.1 months, respectively. Median survival times following ASCT failure were 26 and 7.7 months for patients with HD and NHL, respectively. The second-line international prognostic index (sIPI) and the TTP (before or after 3 months from ASCT) independently were predictive of survival for NHL patients. In addition, treatment with rituximab for patients with B cell NHL was associated with improved survival (median 28.6 vs 4.1 months, P=0.003), independent of the sIPI and TTP. Prognostic factors for patients with HD were not identified. Only two patients, one of whom was among six patients who received second autologous transplants, remain disease-free. The uniformly poor outcome associated with disease progression after ASCT should prompt efforts to assess the feasibility and utility of detecting and treating post transplant residual disease during a minimal disease state, before overt progression.

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Acknowledgements

We are indebted to Drs Daniel Filippa, Julie Feldstein, and Diane Louie for their meticulous review of the pathology specimens. Supported in part by the Mortimer Lacher Fund, the Dewitt Wallace Fund, and Grant No. 5P01CA5826-34 from the National Institutes of Health, Bethesda, MD. TK was a Mortimer J. Lacher Fellow

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Authors and Affiliations

  1. Department of Medicine, Lymphoma and Hematology Services, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    T Kewalramani, S D Nimer, A D Zelenetz, S Malhotra & C H Moskowitz

  2. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    J Yahalom

  3. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    J Qin

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  1. T Kewalramani
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Correspondence to T Kewalramani.

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Kewalramani, T., Nimer, S., Zelenetz, A. et al. Progressive disease following autologous transplantation in patients with chemosensitive relapsed or primary refractory Hodgkin's disease or aggressive non-Hodgkin's lymphoma. Bone Marrow Transplant 32, 673–679 (2003). https://doi.org/10.1038/sj.bmt.1704214

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