Joanna Romejko-Jarosinska, Ewa Paszkiewicz-Kozik, Joanna Tajer, Elzbieta Wojciechowska-Lampka, Martyna Kotarska, Anna Borawska, Lidia Poplawska, Katarzyna Domanska-Czyz, Beata Ostrowska, Wlodzimirz Osiadacz, Michal Osowiecki, Anna Dabrowska-Iwanicka, Monika Swierkowska, Lukasz Targonski, Marcin Szymanski, Robert Konecki, Jan Walewski
Maria Sklodowska Curie Cancer Center and Institute Department of Lymphoproliferative Diseases Warsaw, Poland
With a standard combined modality treatment approach more than 70% of Hodgkin lymphoma (HL) patients (pts) are cured, additional 15% are cured in case of relapse after salvage and high-dose chemotherapy with autologous hematopoietic cell transplantation (autoHCT). The outcome of pts not eligible for autoHCT at time of relapse is uncertain. We retrospectively evaluated long-term outcome including late effects and risk factors in pts with R/R-HL after the first treatment failure. We collected data from 417consecutive pts with R/R-HL after first therapy, treated at our institution between 1990–2016. At diagnosis, median (range) age was 28 (17–62) year, limited, intermediate, advanced stage (GHLSG) was found in 2%, 21%, 77% of pts, respectively. First-line therapy included MOPP or MOPP/ABV regimens in 144pts (35%) and ABVD in 273pts. Involved field radiotherapy was given in 250 (60%) pts.
Results: 200 (48%) and 217 (52%) pts had recurrent and refractory disease, respectively. Median time to progression from the first treatment was 13 months (range 1–248), relapse after 10-ys occurred in 1,5% of pts. 297 pts (72%) underwent autoHCT, 120 pts were not eligible (insufficient CD34 cell collection, progressiion, patient refusal). 9 pts had allogeneic HCT. Median number (range) of therapy lines: before autoHCT and during all therapy were 2 (1–6) and 5 (2–11), respectively. With a median 87month follow-up, 5-year and 10-year OS from the date of relapse/progression was 60% and 50%, respectively. Refractory disease, advanced stage at diagnosis, MOPP as first treatment, and no autoHCT were identified as risk factors associated with inferior OS in multivariate analysis. The risk of death (HR) was: 1.8 (95%CI 1.4, 2.4, p < 0.01), 1.8 (95%CI;1.2, 2.5, p < 0.01), 1.4 (95%CI:1.0 1.8:p = 0.04), 4.8 (95%CI:3.6, 6.2; p < 0.01) for these factors, respectively. In pts not receiving autoHCT the risk of death in relapsed disease and in refractory disease were: 5.6 (95%CI;3.6, 8.8; p < 0.01) and 3.8 (95%CI:2.7, 5.4, p < 0.01) respectively. The main cause of death was progression. Second primary malignancy was occurred in 15pts (3,6%) including 13/297 pts (4,4%) post autoHCT. Two pts had heart transplant after therapy. More than 50% of pts with R/R HL survived 5 years. HDT and autoHCT likely contributed to survival benefit. Refractory disease, stage at diagnosis and type of the first treatment were significant risk factors for long-term survival. The incidence of second primary malignancy was more frequent in post-transplant pts.