Autologous stem cell transplant for early relapsed/refractory Hodgkin lymphoma: Results from two transplant centres

Prior series have demonstrated that early relapsed (within 1year) or refractory Hodgkin lymphoma (HL) is associated with poor prognosis. To determine the outcome for patients with early relapsed/refractory HL in the modern era, we combined data from two large transplant centres, Cleveland Clinic Taussig Cancer Institute (CCTCI) and Memorial Sloan-Kettering Cancer Center (MSKCC), and analysed consecutive patients transplanted for relapsed/refractory HL following induction failure or remission durations of <1year. Two hundred and fourteen patients were analysed and the event-free survival (EFS) and overall survival (OS) at 6years for all patients were 45% and 55%, respectively. Factors significant for prognosis in multivariate analysis were extranodal disease and bulky disease (≥5cm). Patients with 0, 1, or 2 risk factors achieved 6year EFS of 65%, 47%, and 24% and 6year OS of 81%, 55%, and 27%, respectively. Patients with the sole risk factor of early relapsed/refractory disease achieved good outcomes in this large series; however the presence of bulk and/or extranodal disease significantly reduced EFS and OS. Patients with these additional risk factors are best suited for clinical trials investigating novel salvage regimens and post-transplant maintenance strategies.