High-dose chemo-radiotherapy for relapsed or refractory Hodgkin lymphoma and the significance of pre-transplant functional imaging

Research paper

Craig Moskowitz, Joachim Yahalom, Andrew D. Zelenetz, Zhigang Zhang, Daniel Filippa, Julie Teruya-Feldstein, Tarun Kewalramani, Alison J. Moskowitz, Robert David Rice, Jocelyn Maragulia, Jill Vanak, Tanya Trippett, Paul Hamlin, Steven Horowitz, Ariela Noy, Owen A. O'Connor, Carol Portlock, David Straus, Stephen D Nimer

Research output: Contribution to journalArticle

57 Citations (Scopus)

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 languageEnglish
Pages (from-to)890-897
Number of pages8
JournalBritish Journal of Haematology
Volume148
Issue number6
DOIs
StatePublished - Mar 1 2010
Externally publishedYes

Fingerprint

Hodgkin Disease
Radiotherapy
Salvage Therapy
Transplants
Ifosfamide
Disease-Free Survival
Research
Carboplatin
Stem Cell Transplantation
Etoposide
Chemoradiotherapy
Stem Cells
Survival Rate
Tomography
Mortality
Therapeutics

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 journalArticle

Moskowitz, C, Yahalom, J, Zelenetz, AD, Zhang, Z, Filippa, D, Teruya-Feldstein, J, Kewalramani, T, Moskowitz, AJ, Rice, RD, Maragulia, J, Vanak, J, Trippett, T, Hamlin, P, Horowitz, S, Noy, A, O'Connor, OA, Portlock, C, Straus, D & Nimer, SD 2010, 'High-dose chemo-radiotherapy for relapsed or refractory Hodgkin lymphoma and the significance of pre-transplant functional imaging: Research paper', British Journal of Haematology, vol. 148, no. 6, pp. 890-897. https://doi.org/10.1111/j.1365-2141.2009.08037.x
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. / High-dose chemo-radiotherapy for relapsed or refractory Hodgkin lymphoma and the significance of pre-transplant functional imaging : Research paper. In: British Journal of Haematology. 2010 ; Vol. 148, No. 6. pp. 890-897.
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AU - Kewalramani, Tarun

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AU - Rice, Robert David

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AU - Vanak, Jill

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