Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Autografting

High-dose chemotherapy and autologous stem cell transplant in adolescent patients with relapsed or refractory Hodgkin's lymphoma

Bone Marrow Transplantation volume 45, pages 476–482 (2010)Cite this article

Abstract

Fifty-eight adolescent patients with relapsed or primary refractory Hodgkin's lymphoma underwent high-dose chemotherapy (HDC) and autologous SCT (ASCT). The median age at ASCT was 17 years (range 14–21). The disease had relapsed in 24 patients (41%) and was refractory to initial chemotherapy in 34 (59%). ESHAP salvage chemotherapy before ASCT resulted in 88% response. After ASCT, complete remission (CR; including CR-unconfirmed) was seen in 41 patients (71%) and partial remission in 7 (12%). The overall response rate was 83%. One patient did not respond and nine (15%) had progressive disease. Three more patients achieved CR after consolidative radiation post-ASCT. There was no transplant-related mortality. At a median follow-up of 43 months from ASCT, 31 patients (53%) are alive in CR, 5 (9%) are alive with disease and 22 (38%) have died (21 from disease and 1 unrelated). The actuarial probabilities of event-free and overall (OS) survival are 45 and 55% at 11 years. The only negative prognostic factor for OS was the presence of B symptom at relapse or progression (11-year OS 27 vs 60%, P=0.003).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Foltz L, Song K, Connors J . Hodgkin's lymphoma in adolescents. J Clin Oncol 2006; 24: 2520–2526.

    Article  PubMed  Google Scholar 

  2. Canellos G, Anderson J, Propert K, Nissen N, Cooper M, Henderson E et al. Chemotherapy for advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med 1992; 327: 1478–1484.

    Article  CAS  PubMed  Google Scholar 

  3. Linch D, Winfield D, Goldstone A, Moir D, Hancock B, McMillan A et al. Dose intensification with autologous bone-marrow transplantation in relpased and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet 1993; 341: 1051–1054.

    Article  CAS  Google Scholar 

  4. Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. Lancet 2002; 359: 2065–2071.

    Article  CAS  PubMed  Google Scholar 

  5. Longo D, Duffey P, Young R, Hubbard S, Ihde D, Glatstein E et al. Conventional-dose salvage combination chemotherapy in patients relapsing with Hodgkin's disease after combination chemotherapy: the low probability for cure. J Clin Oncol 1992; 10: 210–218.

    Article  CAS  PubMed  Google Scholar 

  6. Bonfante V, Santoro A, Viviani S, Devizzi L, Balzarotti M, Soncini F et al. Outcome of patients with Hodgkin's disease failing after primary MOPP-ABVD. J Clin Oncol 1997; 15: 528–534.

    Article  CAS  PubMed  Google Scholar 

  7. Chopra R, McMillan AK, Linch DC, Yuklea S, Taghipour G, Pearce R et al. The place of high-dose BEAM therapy and autologous bone marrow transplantation in poor-risk Hodgkin's disease. A single-center eight-year study of 155 patients. Blood 1993; 81: 1137 - 1145.

    CAS  PubMed  Google Scholar 

  8. Bierman PJ, Vose JM, Armitage JO . Autologous transplantation for Hodgkin's disease: coming of age? Blood 1994; 83: 1161–1164.

    CAS  PubMed  Google Scholar 

  9. Reece DE, Barnett MJ, Shepherd JD, Hogge DE, Klasa RJ, Nantel SH et al. High-dose cyclophosphamide, carmustine (BCNU), and etoposide (VP16-213) with or without cisplatin (CBV +/- P) and autologous transplantation for patients with Hodgkin's disease who fail to enter a complete remission after combination chemotherapy. Blood 1995; 86: 451–456.

    CAS  PubMed  Google Scholar 

  10. Horning SJ, Chao NJ, Negrin RS, Hoppe RT, Long GD, Hu WW et al. High-dose therapy and autologous hematopoietic progenitor cell transplantation for recurrent or refractory Hodgkin's disease: analysis of the Stanford University results and prognostic indices. Blood 1997; 89: 801–813.

    CAS  PubMed  Google Scholar 

  11. Lazarus HM, Rowlings PA, Zhang MJ, Vose JM, Armitage JO, Bierman PJ et al. Autotransplants for Hodgkin's disease in patients never achieving remission: a report from the Autologous Blood and Marrow Transplant Registry. J Clin Oncol 1999; 17: 534–545.

    Article  CAS  PubMed  Google Scholar 

  12. André M, Henry-Amar M, Pico JL, Brice P, Blaise D, Kuentz M et al. Comparison of high-dose therapy and autologous stem-cell transplantation with conventional therapy for Hodgkin's disease induction failure: a case-control study. Société Francaise de Greffe de Moelle. J Clin Oncol 1999; 17: 222–229.

    Article  PubMed  Google Scholar 

  13. Sweetenham JW, Carella AM, Taghipour G, Cunningham D, Marcus R, Della Volpe A et al. High-dose therapy and autologous stem-cell transplantation for adult patients with Hodgkin's disease who do not enter remission after induction chemotherapy: results in 175 patients reported to the European Group for Blood and Marrow Transplantation. Lymphoma Working Party. J Clin Oncol 1999; 17: 3101–3109.

    Article  CAS  PubMed  Google Scholar 

  14. Josting A, Rueffer U, Franklin J, Sieber M, Diehl V, Engert A . Prognostic factors and treatment outcome in primary progressive Hodgkin lymphoma: a report from the German Hodgkin Lymphoma Study Group. Blood 2000; 96: 1280–1286.

    CAS  PubMed  Google Scholar 

  15. Sureda A, Arranz R, Iriondo A, Carreras E, Lahuerta JJ, García-Conde J et al. Autologous stem-cell transplantation for Hodgkin's disease: results and prognostic factors in 494 patients from the Grupo Español de Linfomas/Transplante Autólogo de Médula Osea Spanish Cooperative Group. J Clin Oncol 2001; 19: 1395–1404.

    Article  CAS  PubMed  Google Scholar 

  16. Fermé C, Mounier N, Diviné M, Brice P, Stamatoullas A, Reman O et al. Intensive salvage therapy with high-dose chemotherapy for patients with advanced Hodgkin's disease in relapse or failure after initial chemotherapy: results of the Groupe d'Etudes des Lymphomes de l'Adulte H89 Trial. J Clin Oncol 2002; 20: 467–475.

    PubMed  Google Scholar 

  17. Czyz J, Szydlo R, Knopinska-Posluszny W, Hellmann A, Gozdzik J, Hansz J et al. Treatment for primary refractory Hodgkin's disease: a comparison of high-dose chemotherapy followed by ASCT with conventional therapy. Bone Marrow Transplant 2004; 33: 1225–1229.

    Article  CAS  PubMed  Google Scholar 

  18. Moskowitz CH, Kewalramani T, Nimer SD, Gonzalez M, Zelenetz AD, Yahalom J . Effectiveness of high dose chemoradiotherapy and autologous stem cell transplantation for patients with biopsy-proven primary refractory Hodgkin's disease. Br J Haematol 2004; 124: 645–652.

    Article  PubMed  Google Scholar 

  19. Lavoie JC, Connors JM, Phillips GL, Reece DE, Barnett MJ, Forrest DL et al. High-dose chemotherapy and autologous stem cell transplantation for primary refractory or relapsed Hodgkin lymphoma: long-term outcome in the first 100 patients treated in Vancouver. Blood 2005; 106: 1473–1478.

    Article  CAS  PubMed  Google Scholar 

  20. Morabito F, Stelitano C, Luminari S, Mammi C, Marcheselli L, Callea V et al. The role of high-dose therapy and autologous stem cell transplantation in patients with primary refractory Hodgkin's lymphoma: a report from the Gruppo Italiano per lo Studio dei Linfomi (GISL). Bone Marrow Transplant 2006; 37: 283–288.

    Article  CAS  PubMed  Google Scholar 

  21. Williams CD, Goldstone AH, Pearce RG, Green S, Armitage JO, Carella A et al. Autologous bone marrow transplantation for pediatric Hodgkin's disease: a case-matched comparison with adult patients by the European Bone Marrow Transplant Group Lymphoma Registry. J Clin Oncol 1993; 11: 2243–2249.

    Article  CAS  PubMed  Google Scholar 

  22. Baker KS, Gordon BG, Gross TG, Abromowitch MA, Lyden ERL, Lynch JC et al. Autologous hematopoietic stem-cell transplantation for relapsed or refractory Hodgkin's disease in children and adolescents. J Clin Oncol 1999; 17: 825–831.

    Article  CAS  PubMed  Google Scholar 

  23. Verdeguer A, Pardo N, Madero L, Martinez A, Bureo E, Fernandez JM et al. Autologous stem cell transplantation for advanced Hodgkin's disease in children. Spanish group for BMT in children (GETMON), Spain. Bone Marrow Transplant 2000; 25: 31–34.

    Article  CAS  PubMed  Google Scholar 

  24. Kobrinsky NL, Sposto R, Shah NR, Anderson JR, DeLaat C, Morse M et al. Outcomes of treatment of children and adolescents with recurrent non-Hodgkin's lymphoma and Hodgkin's disease with dexamethasone, etoposide, cisplatin, cytarabine, and l-asparaginase, maintenance chemotherapy, and transplantation: Children's Cancer Group Study CCG-5912. J Clin Oncol 2001; 19: 2390–2396.

    Article  CAS  Google Scholar 

  25. Lieskovsky YE, Donaldson SS, Torres MA, Wong RM, Amylon MD, Link MP et al. High-dose therapy and autologous hematopoietic stem-cell transplantation for recurrent or refractory pediatric Hodgkin's disease: results and prognostic indices. J Clin Oncol 2004; 22: 4532–4540.

    Article  PubMed  Google Scholar 

  26. Schellong G, Dörffel W, Claviez A, Körholz D, Mann G, Scheel-Walter H et al. Salvage therapy of progressive and recurrent Hodgkin's disease: results from a multicenter study of the pediatric DAL/GPOH-HD study group. J Clin Oncol 2005; 23: 6181–6189.

    Article  PubMed  Google Scholar 

  27. Petropoulos D, Worth L, Mullen C, Lockhart S, Choroszy M, Chan K . Interferon-alpha after autologous stem cell transplantation in pediatric patients with advanced Hodgkin's lymphoma. Bone Marrow Transplant 2006; 38: 345–349.

    Article  CAS  PubMed  Google Scholar 

  28. Akhtar S, Tbakhi A, Humaidan H, El Weshi A, Rahal M, Maghfoor I . ESHAP + fixed dose G-CSF as autologous peripheral blood stem cell mobilization regimen in patients with relapsed or refractory diffuse large cell and Hodgkin's lymphoma: a single institution result of 127 patients. Bone Marrow Transplant 2006; 37: 277–282.

    Article  CAS  PubMed  Google Scholar 

  29. Hasenclever D, Diehl V . A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med 1998; 339: 1506–1514.

    Article  CAS  Google Scholar 

  30. Sureda A, Constans M, Iriondo A, Arranz R, Caballero MD, Vidal MJ et al. Prognostic factors affecting long-term outcome after stem cell transplantation in Hodgkin's lymphoma autografted after a first relapse. Ann Oncol 2005; 16: 625–633.

    Article  CAS  PubMed  Google Scholar 

  31. Czyz J, Hellmann A, Dziadziuszko R, Hansz J, Gozdzik J, Holowiecki J et al. High-dose chemotherapy with autologous stem cell transplantation is an effective treatment of primary refractory Hodgkin's disease. Retrospective study of the Polish Lymphoma Research Group. Bone Marrow Transplant 2002; 30: 29–34.

    Article  CAS  PubMed  Google Scholar 

  32. Yuen AR, Rosenberg SA, Hoppe RT, Halpern JD, Horning SJ . Comparison between conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory Hodgkin's disease. Blood 1997; 89: 814–822.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Mr Ibrahim Abdullah El-Hassan for statistical analysis; Ms Ruqaya Belkhedim, Mr Fayez Abu Zeid, Ms Julie Stensness and Ms Fadia Mansour from the BMT Clinic and Mr Edgardo Colcol and Marybeth Dingle from Oncology Data Unit for their valuable contribution. No research grant or support was provided for this analysis. This study was approved by Institutional Research Advisory Counsel as a retrospective analysis study.

Author information

Authors and Affiliations

  1. Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia

    S Akhtar, M Abdelsalam, H Al Husseini & I Maghfoor

  2. Service d'Oncologie, Centre Hospitalier Public du Cotentin, Cherbourg-Octeville, France

    A El Weshi

  3. Department of Oncology, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia

    M Rahal

Authors
  1. S Akhtar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A El Weshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Rahal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M Abdelsalam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H Al Husseini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I Maghfoor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S Akhtar.

Additional information

The information in this paper has previously been presented in the studies cited in the Appendix.

Appendix

Appendix

Akhtar S, El Weshi A, Rahal M, M, Abdelsalam, Jinabi I, Hussaini H, Maghfoor I. High dose chemotherapy and autologous stem cell transplant in adolescent patients with relapsed or refractory Hodgkin's lymphoma: clinical outcome and impact of prognostic factors in 53 patients. Haematologica 2007; 92:s1: 354, abstract 0950.

Akhtar S, El Weshi A, Rahal M, M, Abdelsalam, Jinabi I, Hussaini H, Maghfoor I. Clinical outcome and prognostic factors evaluation in adolescent patients with relapsed or refractory Hodgkins lymphoma receiving autologous stem cell transplant. Paediatric Blood and Cancer 2007. November Issue (Abstract).

Akhtar S, El Weshi A, Rahal M, Abdelsalam M, I, Hussaini H, Maghfoor I. High-dose chemotherapy and autologous stem cell transplant for relapsed or refractory Hodgkin's lymphoma in 58 adolescent patients. Evaluation of prognostic factors and their impact on survival. Bone Marrow Transplant 2009; 43(suppl 1):S207, Abstract P 751.

Poster presentation at 35th European Group for Blood and Marrow Transplantation. Göteborg, Sweden, 29 March–1 April 2009.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Akhtar, S., El Weshi, A., Rahal, M. et al. High-dose chemotherapy and autologous stem cell transplant in adolescent patients with relapsed or refractory Hodgkin's lymphoma. Bone Marrow Transplant 45, 476–482 (2010). https://doi.org/10.1038/bmt.2009.197

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.197

Keywords

This article is cited by

Search

Advanced search

Quick links