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Blood, 15 August 2005, Vol. 106, No. 4, pp. 1473-1478.
Prepublished online as a Blood First Edition Paper on May 3, 2005; DOI 10.1182/blood-2004-12-4689.
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Submitted December 13, 2004
Accepted March 31, 2005
High-dose chemotherapy and autologous stem cell transplantation for primary refractory or relapsed Hodgkin Lymphoma: long-term outcome in the first 100 patients treated in Vancouver
Julye C Lavoie*, Joseph M Connors, Gordon L Phillips, Donna E Reece, Michael J Barnett, Donna L Forrest, Randy D Gascoyne, Donna E Hogge, Stephen H Nantel, John D Shepherd, Clayton A Smith, Kevin W Song, Heather J Sutherland, Cynthia L Toze, Nicholas J Voss, and Thomas J Nevill
Leukemia/Bone Marrow Transplantation Program of British Columbia, Division of Hematology, Vancouver General Hospital, Vancouver, BC, Canada
Department of Medical Oncology, British Columbia Cancer Agency; and the University of British Columbia, Vancouver, BC, Canada
Department of Pathology, British Columbia Cancer Agency; and the University of British Columbia, Vancouver, BC, Canada
Department of Radiation Oncology, British Columbia Cancer Agency; and the University of British Columbia, Vancouver, BC, Canada
* Corresponding author; email: jlavoie{at}bccancer.bc.ca.
Beginning in 1985, patients in British Columbia with Hodgkin Lymphoma (HL) that was not controlled by conventional chemotherapy routinely underwent high dose chemotherapy and autologous stem cell transplantation (HD-ASCT). Long-term complications of HD-ASCT have become apparent as more patients survive without recurrence of HL. Data was obtained retrospectively on the first 100 patients that underwent HD-ASCT for HL in Vancouver focusing on relapse, treatment-related complications and the occurrence of late events. Fifty-three patients remain alive [median follow-up 11.4 years (range 10.0-17.4)] with an overall survival (OAS) of 54% at 15 years. OAS was significantly better in first relapse patients (67%) than in patients with refractory/induction failure (39%) and advance disease (29%) (p=0.002). The major cause of death was progression of HL (32% at 15 years). Treatment related mortality including death from second malignancy was 17% at 15 years. Cumulative risk of a second malignancy was 9% at 15 years. KPS was  90% in 47 patients although hypogonadism (20 patients), hypothyroidism (12), unusual infections (10), anxiety/depression (7), and cardiac disease (5) were not uncommon in survivors. HD-ASCT can lead to durable remissions in relapsed/refractory HL with acceptable but definite late toxicity. The occurrence of late events necessitates lifelong medical surveillance.
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