1. ¹Department of Haematology, Hammersmith Hospitals NHS Trust, Imperial College School of Medicine, London, UK
2. ²Department of Histopathology, Hammersmith Hospitals NHS Trust, Imperial College School of Medicine, London, UK

Correspondence: Dr EJ Kanfer, Department of Haematology, Hammersmith Hospitals NHS Trust, Imperial College School of Medicine, Du Cane Road, London W12 0HS, UK. E-mail: ekanfer@imperial.ac.uk

Received 21 June 2006; Revised 20 October 2006; Accepted 20 October 2006; Published online 20 November 2006.

Abstract

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a recognized treatment option for patients with relapsed Hodgkin's lymphoma. We have analysed 67 patients who underwent ASCT after LACE (lomustine (CCNU), cytarabine (Ara-C), cyclophosphamide, etoposide) conditioning for relapsed (n=61) or primary refractory (n=6) Hodgkin's lymphoma. The 100-day treatment-related mortality was 3%. With a median follow-up of 67 months (range 3.3–161.0) the probabilities of overall survival (OS) and progression-free survival (PFS) at 5 years were 68 and 64%, respectively. Probabilities for OS and PFS at 5 years for patients with chemosensitive relapse (n=40) were 81 and 78% versus 50 and 35%, respectively, for patients (n=27) with chemoresistant relapse (P=0.012 for OS, P=0.002 for PFS). In multivariate analysis mixed cellularity classical or lymphocyte-depleted classical histology subtype and haemoglobin level of 10 g/dl or less at the time of ASCT were identified as risk factors for worse OS, whereas stage III or IV disease at diagnosis and disease status at ASCT other than complete or partial remission predicted inferior PFS. LACE followed by ASCT is an effective treatment for the majority of patients with chemosensitive relapsed Hodgkin's lymphoma and a proportion of chemorefractory patients also benefit.