Published online 9 December 2008
Haematologica, Vol 94, Issue 2, 230-238 doi:10.3324/haematol.13441
Copyright © 2009 by Ferrata Storti Foundation

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Hodgkin's Lymphoma

Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin’s lymphoma: identification of prognostic factors predicting outcome

Stephen P. Robinson¹, Anna Sureda², Carmen Canals³, Nigel Russell⁴, Dolores Caballero⁵, Andrea Bacigalupo⁶, Arturo Iriondo⁷, Gordon Cook⁸, Andrew Pettitt⁹, Gerard Socie¹⁰, Francesca Bonifazi¹¹, Alberto Bosi¹², Mauricette Michallet¹³, Effie Liakopoulou¹⁴, Johan Maertens¹⁵, Jakob Passweg¹⁶, Fiona Clarke¹⁷, Rodrigo Martino², Norbert Schmitz¹⁸ on behalf of the Lymphoma Working Party of the EBMT

¹ BMT Unit, Bristol Children’s Hospital, UK
² Clinical Hematology Division, Hospital Santa Creu i Sant Pau, Barcelona, Spain
³ Lymphoma Working Party of the EBMT, Barcelona, Spain
⁴ Department of Hematology, Nottingham City Hospital, UK
⁵ Hematology Service, Hospital Clínico, Salamanca, Spain
⁶ Department of Hematology, Ospedale San Martino, Genova, Italy
⁷ Servicio Hematologia, Hospital U. Marques de Valdecilla, Santander, Spain
⁸ Department of Hematology, St James’s University Hospital, Leeds, UK
⁹ Department of Hematology, Royal Liverpool University Hospital, UK
¹⁰ Department of Hematology, Hôpital St. Louis, Paris, France
¹¹ Institute of Hematology and Medical Oncology, Bologna University, Italy
¹² Department of Hematology, Ospedale di Careggi, Firenze, Italy
¹³ BMT Unit, Hôpital E. Herriot, Lyon, France
¹⁴ Christie Hospital, Manchester, UK
¹⁵ Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
¹⁶ Department of Internal Medicine, Hôpitaux Universitaires de Geneve, Geneva, Switzerland
¹⁷ Department of Hematology, University of Birmingham, UK and
¹⁸ Department of Hematology, AK-St Georg, Hamburg, Germany

Correspondence: Stephen Paul Robinson, BMT Unit, Bristol Children’s Hospital, Upper Maudlin Street, Bristol BS2 8BJ, United Kingdom. E-mail:stephen.robinson{at}ubht.swest.nhs.uk

Background: The role of reduced intensity conditioning allogeneic stem transplantation (RICalloSCT) in the management of patients with Hodgkin’s lymphoma remains controversial.

Design and Methods: To further define its role we have conducted a retrospective analysis of 285 patients with HL who underwent a RICalloSCT in order to identify prognostic factors that predict outcome. Eighty percent of patients had undergone a prior autologous stem cell transplantation and 25% had refractory disease at transplant.

Results: Non-relapse mortality was associated with chemorefractory disease, poor performance status, age >45 and transplantation before 2002. For patients with no risk factors the 3-year non-relapse mortality rate was 12.5% compared to 46.2% for patients with 2 or more risk factors. The use of an unrelated donor had no adverse effect on the non-relapse mortality. Acute graft versus host disease (aGVHD) grades II–IV developed in 30% and chronic GVHD in 42%. The development of cGVHD was associated with a lower relapse rate. The disease progression rate at one and five years was 41% and 58.7% respectively and was associated with chemorefractory disease and extent of prior therapy. Donor lymphocyte infusions were administered to 64 patients for active disease of whom 32% showed a clinical response. Eight out of 18 patients receiving donor lymphocyte infusions alone had clinical responses. Progression-free and overall survival were both associated with performance status and disease status at transplant. Patients with neither risk factor had a 3-year PFS and overall survival of 42% and 56% respectively compared to 8% and 25% for patients with one or more risk factors. Relapse within six months of a prior autologous transplant was associated with a higher relapse rate and a lower progression-free.

Conclusions: This analysis identifies important clinical parameters that may be useful in predicting the outcome of RICaIICalloSCT in Hodgkin’s lymphoma.

Key words: Hodgkin’s lymphoma, allogeneic transplantation, prognosis.

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