Abstract
We previously reported that three risk factors (RF): initial remission duration <1 year, active B symptoms, and extranodal disease predict outcome in relapsed or refractory Hodgkin lymphoma (HL). Our goal was to improve event-free survival (EFS) for patients with multiple RF and to determine if response to salvage therapy impacted outcome. We conducted a phase II intent-to-treat study of tailored salvage treatment: patients with zero or one RF received standard-dose ifosfamide, carboplatin, and etoposide (ICE); patients with two RF received augmented ICE; patients with three RF received high-dose ICE with stem cell support. This was followed by evaluation with both computed tomography and functional imaging (FI); those with chemosensitive disease underwent high-dose chemoradiotherapy and autologous stem cell transplantation (ASCT). There was no treatment-related mortality. Compared to historical controls this therapy eliminated the difference in EFS between the three prognostic groups. Pre-ASCT FI predicted outcome; 4-year EFS rates was 33% vs. 77% for patients transplanted with positive versus negative FI respectively, P = 0·00004, hazard ratio 4·61. Risk-adapted augmentation of salvage treatment in patients with HL is feasible and improves EFS in poorer-risk patients. Our data suggest that normalisation of FI pre-ASCT predicts outcome, and should be the goal of salvage treatment.
| Original language | English |
|---|---|
| Pages (from-to) | 890-897 |
| Number of pages | 8 |
| Journal | British Journal of Haematology |
| Volume | 148 |
| Issue number | 6 |
| DOIs | |
| State | Published - Mar 1 2010 |
| Externally published | Yes |
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Keywords
- High-dose chemoradiotherapy
- Hodgkin Lymphoma
- HSCT
ASJC Scopus subject areas
- Hematology
Cite this
High-dose chemo-radiotherapy for relapsed or refractory Hodgkin lymphoma and the significance of pre-transplant functional imaging : Research paper. / Moskowitz, Craig; Yahalom, Joachim; Zelenetz, Andrew D.; Zhang, Zhigang; Filippa, Daniel; Teruya-Feldstein, Julie; Kewalramani, Tarun; Moskowitz, Alison J.; Rice, Robert David; Maragulia, Jocelyn; Vanak, Jill; Trippett, Tanya; Hamlin, Paul; Horowitz, Steven; Noy, Ariela; O'Connor, Owen A.; Portlock, Carol; Straus, David; Nimer, Stephen D.
In: British Journal of Haematology, Vol. 148, No. 6, 01.03.2010, p. 890-897.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - High-dose chemo-radiotherapy for relapsed or refractory Hodgkin lymphoma and the significance of pre-transplant functional imaging
T2 - Research paper
AU - Moskowitz, Craig
AU - Yahalom, Joachim
AU - Zelenetz, Andrew D.
AU - Zhang, Zhigang
AU - Filippa, Daniel
AU - Teruya-Feldstein, Julie
AU - Kewalramani, Tarun
AU - Moskowitz, Alison J.
AU - Rice, Robert David
AU - Maragulia, Jocelyn
AU - Vanak, Jill
AU - Trippett, Tanya
AU - Hamlin, Paul
AU - Horowitz, Steven
AU - Noy, Ariela
AU - O'Connor, Owen A.
AU - Portlock, Carol
AU - Straus, David
AU - Nimer, Stephen D
PY - 2010/3/1
Y1 - 2010/3/1
N2 - We previously reported that three risk factors (RF): initial remission duration <1 year, active B symptoms, and extranodal disease predict outcome in relapsed or refractory Hodgkin lymphoma (HL). Our goal was to improve event-free survival (EFS) for patients with multiple RF and to determine if response to salvage therapy impacted outcome. We conducted a phase II intent-to-treat study of tailored salvage treatment: patients with zero or one RF received standard-dose ifosfamide, carboplatin, and etoposide (ICE); patients with two RF received augmented ICE; patients with three RF received high-dose ICE with stem cell support. This was followed by evaluation with both computed tomography and functional imaging (FI); those with chemosensitive disease underwent high-dose chemoradiotherapy and autologous stem cell transplantation (ASCT). There was no treatment-related mortality. Compared to historical controls this therapy eliminated the difference in EFS between the three prognostic groups. Pre-ASCT FI predicted outcome; 4-year EFS rates was 33% vs. 77% for patients transplanted with positive versus negative FI respectively, P = 0·00004, hazard ratio 4·61. Risk-adapted augmentation of salvage treatment in patients with HL is feasible and improves EFS in poorer-risk patients. Our data suggest that normalisation of FI pre-ASCT predicts outcome, and should be the goal of salvage treatment.
AB - We previously reported that three risk factors (RF): initial remission duration <1 year, active B symptoms, and extranodal disease predict outcome in relapsed or refractory Hodgkin lymphoma (HL). Our goal was to improve event-free survival (EFS) for patients with multiple RF and to determine if response to salvage therapy impacted outcome. We conducted a phase II intent-to-treat study of tailored salvage treatment: patients with zero or one RF received standard-dose ifosfamide, carboplatin, and etoposide (ICE); patients with two RF received augmented ICE; patients with three RF received high-dose ICE with stem cell support. This was followed by evaluation with both computed tomography and functional imaging (FI); those with chemosensitive disease underwent high-dose chemoradiotherapy and autologous stem cell transplantation (ASCT). There was no treatment-related mortality. Compared to historical controls this therapy eliminated the difference in EFS between the three prognostic groups. Pre-ASCT FI predicted outcome; 4-year EFS rates was 33% vs. 77% for patients transplanted with positive versus negative FI respectively, P = 0·00004, hazard ratio 4·61. Risk-adapted augmentation of salvage treatment in patients with HL is feasible and improves EFS in poorer-risk patients. Our data suggest that normalisation of FI pre-ASCT predicts outcome, and should be the goal of salvage treatment.
KW - High-dose chemoradiotherapy
KW - Hodgkin Lymphoma
KW - HSCT
UR - http://www.scopus.com/inward/record.url?scp=77649207012&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77649207012&partnerID=8YFLogxK
U2 - 10.1111/j.1365-2141.2009.08037.x
DO - 10.1111/j.1365-2141.2009.08037.x
M3 - Article
VL - 148
SP - 890
EP - 897
JO - British Journal of Haematology
JF - British Journal of Haematology
SN - 0007-1048
IS - 6
ER -