Risk Factors Predicting Outcomes of Autologous Hematopoietic Cell Transplantation (autoHCT) in Children, Adolescents and Young Adults (CAYA) with Relapsed/Refractory (Rel/Ref) Classical Hodgkin Lymphoma (HL): A CIBMTR Analysis

Introduction: AutoHCT is a potentially curative modality for Rel/Ref HL. However, large studies evaluating the risk factors predicting outcomes of autoHCT in CAYA with Rel/Ref HL have not been performed.

Methods: CAYA (age <30yrs) with Rel/Ref classical HL undergoing autoHCT during 1995-2010 were eligible. HIV+ patients and those undergoing tandem HCT were excluded.

Results: Baseline characteristics of 671 CAYA included in the analysis are shown in Table. The 3yr non-relapse mortality (NRM), rate of relapse/progression (R/P), progression free survival (PFS) and overall survival (OS) were 6%, 38%, 56% and 73%, respectively. On multivariate analysis non-ABVD/ABVD-like 1st line therapy (RR 1.8; p=0.03) was associated with a higher NRM. Factors predicting higher risk of R/P included Lansky score (LS) or KPS<90 (RR 1.6; p=0.0006), extranodal disease (END) (RR 1.6; p=0.001), resistant disease (RR 1.8; p<0.0001) and CBV conditioning (RR 1.6; p=0.002). Long first complete remission (LgCR1; ≥1yr) was associated with a reduced R/P risk (RR 0.6; p=0.003). MVA for PFS identified END (RR 1.5; p=0.001), resistant disease (RR 1.9; p<0.0001) and KPS<90 (RR 1.5; p=0.0004) as risk factors for therapy failure; while LgCR1 (0.7; p=0.006) was predictive of reduced therapy failure risk. Finally for OS, non-ABVD/ABVD-like 1st line therapy (RR 1.5; p=0.001), END (RR 1.7; p=.0003) and resistant disease (RR 2.3; p<0.0001) were associated with higher mortality; while LgCR1 (RR 0.5; p=0.0006) and peripheral blood graft (RR 0.49, p=0.0001) were associated with reduced mortality risk. Age was not predictive of autoHCT outcomes.

Conclusions:  Unlike adult HL patients, age is not a prognostic factor for CAYA outcomes following autoHCT. In this largest CAYA study to date; LgCR1, LS/KPS, chemoresistance, END and non-ABVD/ABVD-like 1st line therapy emerge as factors predicting autoHCT survival outcomes in CAYA with HL. These data help identify potential high risk Rel/Ref CAYA with HL, where investigation of novel post autoHCT (maintenance, consolidation, immunomodulatory etc.) approaches is warranted.

 

Baseline characteristics	N=671 (%)
Median age (range)	23 (3-29)
<21 yrs	230 (34)
KPS ≥90	498 (74)
Duration of 1st CR     <12mons (including primary refractory)     ≥12mons     Missing	361 (54) 237 (35) 73 (11)
Time from diagnosis to HCT, mons (range)	19 (3-238)
High LDH at HCT	174 (26)
Median lines of therapies (range)	2 (1-5)
ABVD or ABVD-like 1st line therapy	396 (59)
END at HCT	118 (18)
Bulky disease at HCT	77 (11)
Disease status at HCT     Sensitive     Resistant     Missing	529 (79) 125 (19) 17 ( 3)
Radiation post HCT	205 (31)
Conditioning     BEAM     CBV     Others	455 (68) 80 (12) 136 ( 20)
Graft type     BM     PB	65 (10) 606 (90)
Median follow-up, mons (range)	64 (4-216)

 

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