Risk factors and a prognostic score for survival after autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma

P. J. Bröckelmann, H. Müller, O. Casasnovas, M. Hutchings, B. von Tresckow, M. Jürgens, S. J. McCall, F. Morschhauser, M. Fuchs, P. Borchmann, Craig Moskowitz, A. Engert

Research output: Contribution to journalArticle

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Abstract

Background: Novel agents are changing the treatment of relapsed or refractory Hodgkin lymphoma (HL). Nevertheless, high-dose chemotherapy and autologous stem-cell transplantation (ASCT) are considered standard of care in eligible patients. To identify patients who could benefit most from novel therapeutic approaches, we investigated a comprehensive set of riskfactors (RFs) for survival after ASCT. Methods: In this multinational prognostic multivariable modeling study, 23 potential RFs were retrospectively evaluated in HLpatients from nine prospective trials with multivariable Cox proportional hazards regression analyses (part I). The resultingprognostic score was then validated in an independent clinical sample (part II).Results: In part I, we identified 656 patients treated for relapsed/refractory HL between 1993 and 2013 with a median follow-upof 60 months after ASCT. The majority of potential RFs had significant impact on progression-free survival (PFS) with hazardratios (HR) ranging from 1.39 to 2.22. The multivariable analysis identified stage IV disease, time to relapse≤3 months, ECOG performancestatus≥1, bulk≥5 cm and inadequate response to salvage chemotherapy [<partial remission by computed tomography(CT)] as significant and non-redundant RFs for PFS. A risk score composed of these equally weighed RFs was significantlyprognostic for PFS (HR=1.67 for each additional RF; P<0.0001). Validation in an independent sample of 389 patients treated indifferent clinical settings with evaluation of response to salvage therapy by functional imaging instead of CT confirmed the excellentdiscrimination of risk groups and significant prognostication of PFS and overall survival (OS) after ASCT (HR=1.70 andHR=1.63, respectively; P<0.0001).Conclusions: Based on this large study (n=1045), precise and valid risk prognostication in HL patients undergoing ASCT canbe achieved with five easily available clinical RFs. The proposed prognostic score hence allows reliable stratification of patientsfor innovative therapeutic approaches in clinical practice and future trials.

Original languageEnglish (US)
Article numbermdx072
Pages (from-to)1352-1358
Number of pages7
JournalAnnals of Oncology
Volume28
Issue number6
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

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Stem Cell Transplantation
Hodgkin Disease
Disease-Free Survival
Survival
Tomography
Drug Therapy
Salvage Therapy
Standard of Care
Therapeutics
Regression Analysis

Keywords

  • ASCT
  • Hodgkin lymphoma
  • Prognosis
  • Relapse
  • Risk factors
  • Score

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Bröckelmann, P. J., Müller, H., Casasnovas, O., Hutchings, M., von Tresckow, B., Jürgens, M., ... Engert, A. (2017). Risk factors and a prognostic score for survival after autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma. Annals of Oncology, 28(6), 1352-1358. [mdx072]. https://doi.org/10.1093/annonc/mdx072

Risk factors and a prognostic score for survival after autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma. / Bröckelmann, P. J.; Müller, H.; Casasnovas, O.; Hutchings, M.; von Tresckow, B.; Jürgens, M.; McCall, S. J.; Morschhauser, F.; Fuchs, M.; Borchmann, P.; Moskowitz, Craig; Engert, A.

In: Annals of Oncology, Vol. 28, No. 6, mdx072, 01.06.2017, p. 1352-1358.

Research output: Contribution to journalArticle

Bröckelmann, PJ, Müller, H, Casasnovas, O, Hutchings, M, von Tresckow, B, Jürgens, M, McCall, SJ, Morschhauser, F, Fuchs, M, Borchmann, P, Moskowitz, C & Engert, A 2017, 'Risk factors and a prognostic score for survival after autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma', Annals of Oncology, vol. 28, no. 6, mdx072, pp. 1352-1358. https://doi.org/10.1093/annonc/mdx072
Bröckelmann PJ, Müller H, Casasnovas O, Hutchings M, von Tresckow B, Jürgens M et al. Risk factors and a prognostic score for survival after autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma. Annals of Oncology. 2017 Jun 1;28(6):1352-1358. mdx072. https://doi.org/10.1093/annonc/mdx072
Bröckelmann, P. J. ; Müller, H. ; Casasnovas, O. ; Hutchings, M. ; von Tresckow, B. ; Jürgens, M. ; McCall, S. J. ; Morschhauser, F. ; Fuchs, M. ; Borchmann, P. ; Moskowitz, Craig ; Engert, A. / Risk factors and a prognostic score for survival after autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma. In: Annals of Oncology. 2017 ; Vol. 28, No. 6. pp. 1352-1358.
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