269 Autologous Transplantation for Hodgkin disease: A Tale of Two Eras

Track: Contributed Abstracts
Wednesday, February 13, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Phillip M Garfin, MD PhD , Pediatrics, Stanford University, Palo Alto, CA
Sandra Luna-Fineman, MD , Pediatrics, Stanford University, Palo Alto, CA
Michael Amylon, MD , Dept. of Pediatrics, Stanford University Medical Center, Stanford, CA
Sandhya Kharbanda, MD , Pediatric Stem Cell Transplant, Stanford University, Palo Alto, CA
Kenneth I Weinberg, MD , Stanford University School of Medicine, Palo Alto, CA
Jennifer Reikes Willert, MD , Pediatric Hematology/Oncology/BMT, Rady Children's Hospital/Ucsd, San Diego, CA
Matthew Porteus, MD, PhD , Stanford University
Michael Link, MD , Pediatrics, Stanford University, Palo Alto, CA
Rajni Agarwal, MD , Pediatric Stem Cell Transplantation, Stanford University, Palo Alto, CA
Purpose

We evaluated outcomes for pediatric patients who underwent autologous hematopoietic stem-cell transplantation (AHSCT) for refractory or recurrent Hodgkin Disease (HD) to identify factors that contribute to the success or failure of their treatment.

Patients and Methods

From 1988 to 2012, 89 patients <21 years with relapsed or refractory HD underwent high-dose therapy followed by AHSCT according to one of several autologous transplantation protocols at Stanford University Medical Center (Stanford, CA). Pretreatment factors were analyzed by univariate and multivariate analysis for prognostic significance for 5-year overall survival (5 yr OS).

Results

The majority of the patients received a BCNU, etoposide, and cyclophosphamide conditioning regimen. The 5 yr OS in these patients was greater than that of recipients of either other chemotherapy-only preparative  (e.g. CCNU, etoposide, cyclophosphamide or gemcitabine, vinorelbine, etoposide, cyclophosphamide) or  radiation-containing regimens (75%, 61%, 50% respectively; p = 0.0057).   AHSCT at or before second relapse resulted in better 5 yr OS than AHSCT later in the disease course (73% v 51%, p=0.4).  Patients who underwent AHSCT in 2002 or later had significantly better OS than those who underwent transplantation between 1988 and 2001 (80% v 65%; p = 0.07).  Those in the earlier era were almost twice as likely to die within 5 years (risk ratio 1.97).  This improvement in outcome is present even among patients who received BCNU containing conditioning (82% 5 yr OS 2002-2012 vs. 71% 5 yr OS 1988-2001, p =0.21, risk ratio 1.89). 5 yr OS correlated most strongly with the era of transplantation. Most of the difference in outcome was attributable to decreased mortality in the peri-transplant period.

Conclusion

Approximatley three-fourths of children who underwent AHSCT for their recurrent or refractory HD can be successfully treated with current therapy, confirming the continued efficacy of this approach. Analyses of results by treatment era suggest that supportive care during the peri-transplant period has improved outcomes. The BCNU, etoposide, and cyclophosphamide regimen was at least as effective as BEAM, and had greater OS than many published reports about outcomes using BEAM.  Since outcome was related to disease status, pediatric patients should undergo AHSCT prior to second relapse.

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