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Conditioning Regimens

A prognostic model for prolonged event-free survival after autologous or allogeneic blood or marrow transplantation for relapsed and refractory Hodgkin's disease

Bone Marrow Transplantation volume 35, pages 557–566 (2005)Cite this article

Summary:

There are several prognostic models for Hodgkin's disease (HD) patients, but none evaluating patient characteristics at time of blood and marrow transplantation (BMT). We developed a prognostic model for event-free survival (EFS) post-BMT based on HD patient characteristics measured at the time of autologous (auto) or allogeneic (allo) BMT. Between 1/1991 and 12/2001, 64 relapsed or refractory HD patients received an auto (n=46) or allo (n=18) BMT. A multivariate prognostic model was developed measuring time to relapse, progression or death. Median follow-up was 51.7 months; median EFS for auto and allo BMT was 36 and 3 months, respectively (P=0.001). Significant multivariate predictors of shorter EFS were chemotherapy-resistant disease, KPS <90 and ⩾3 chemotherapy regimens pre-BMT. Patients with two to three adverse factors had significantly shorter EFS at 2 years (58 vs 11% in auto; 38 vs 0% in allo BMT patients). Despite a selection bias favoring auto BMT, the model was valid in both auto and allo BMT groups. We were able to differentiate patients at high vs low risk for adverse outcomes post-BMT. This prognostic model may prove useful in predicting patient outcomes and identifying high-risk patients for novel treatment strategies. Validation of this model in a larger cohort of patients is warranted.

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Acknowledgements

We thank Dr James Kepner, Chair of Biostatistics, Roswell Park Cancer Institute, for reviewing and commenting on the manuscript, the clinical services, data managers and transplant co-ordinators for help with data collection, and Ms Dorothy Macchio for editorial assistance.

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  1. T Hahn and M Benekli: These two authors contributed equally to this work

Authors and Affiliations

  1. Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA

    T Hahn, M Benekli, A Alam, M R Baer, M S Czuczman, M Wetzler & P L McCarthy

  2. Department of Education, Roswell Park Cancer Institute, Buffalo, New York, USA

    C Wong & A M Michalek

  3. Department of Epidemiology, Roswell Park Cancer Institute, Buffalo, New York, USA

    K B Moysich & A Hyland

  4. Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, New York, USA

    B Bambach

  5. Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA

    J L Becker

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Hahn, T., Benekli, M., Wong, C. et al. A prognostic model for prolonged event-free survival after autologous or allogeneic blood or marrow transplantation for relapsed and refractory Hodgkin's disease. Bone Marrow Transplant 35, 557–566 (2005). https://doi.org/10.1038/sj.bmt.1704789

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