High-dose chemotherapy and autologous stem cell transplant as first salvage treatment for relapsed or refractory Hodgkin Lymphoma in the era of PET-adapted strategies

Abstract

Data on the efficacy of high-dose chemotherapy and autologous stem cell transplantation (ASCT) for classical Hodgkin lymphoma (cHL) patients who failed a PET-driven first-line therapy are limited.

We retrospectively evaluated 220 adult cHL patients who underwent ASCT from 2009 to 2021 at 11 centers in Italy. Overall, 49.5% had refractory disease, 23.2% relapsed < 12 and 27.3% ≥12 months from the end of first-line chemotherapy. The 3-year progression-free survival (PFS) and overall survival (OS) were 73.8% and 89.4%. In univariable analysis for PFS events PET-2+ (HR 2.69, p = .001), anemia (HR 2.22, p = .019), refractory disease (HR 1.76, p = .045), less than CR before ASCT (HR 3.24, p < .001) and >2 lines of salvage therapy (HR 2.52; p = .004) were associated with a higher risk of failure after ASCT. In multivariable analysis, >2 lines of salvage therapy (HR 3.28, p = .004) and RT before ASCT (HR 3.00, p = 0.041) retained significance.

ASCT is an effective salvage approach for cHL patients treated in the era of PET-adapted therapies.

Keywords:

• Hodgkin lymphoma
• relapse
• refractory disease
• autologous stem cell transplant
• PET-2
• PET-adapted strategy

Acknowledgements

We thank San Francisco Edit for editing of our manuscript. Part of the research activities of this study have been made feasible by research grants from Banca del Piemonte and Fondazione Venesio and from Piaggio S.p.A. to CT.

Ethics statement

The study was approved by the ethics committees of the participating centers and authorized by the Clinical Trial Office of IEO (No. 1355).

Author contributions

Concept and design: SV and CT; Data collection: All authors; Statistical analysis and interpretation: SF, VB, SV and CT; Manuscript writing: SV and CT; Manuscript review and approval: All authors; Accountable for all aspects of the work: All authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Previous study presentation

This study was presented in part during the 12th International Symposium on Hodgkin Lymphoma (ISHL12), October 22–24, 2022

Data availability statement

The data that support the findings of this study are available from the corresponding author upon request.