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Blood, 15 August 2000, Vol. 96, No. 4, pp. 1280-1286
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Prognostic factors and treatment outcome in primary
progressive Hodgkin lymphoma: a report from the German
Hodgkin Lymphoma Study Group
Andreas Josting,
Ulrich Rueffer,
Jeremy Franklin,
Markus Sieber,
Volker Diehl, and
Andreas Engert
From the First Department of Internal Medicine,
University Hospital Cologne, and the German Hodgkin Lymphoma Study
Group.
To determine prognostic factors and treatment outcome, patients
with primary progressive Hodgkin lymphoma (HD) registered in the
database of the German Hodgkin Lymphoma Study Group (GHSG) were
analyzed retrospectively. Detailed records from randomized prospective
multicenter trials performed between 1988 and 1998 of 3807 patients
recruited in these trials were reviewed. The median age of the 206 patients available was 34 years (range, 16-71). Fifty-seven patients
(28%) in intermediate stage and 149 patients (72%) in advanced stage
developed progressive disease (PD). One hundred and fifty-three
patients (74%) were treated with salvage chemotherapy, 47 patients
(23%) with salvage radiotherapy, and 6 patients (3%) did not receive
any therapy due to rapid PD. Seventy patients (34%) were treated with
high-dose chemotherapy (HDCT) and autologous stem cell transplantation.
The 5-year freedom from second failure (FF2F) and overall survival (OS)
for all patients were 17% and 26%, respectively. The 5-year FF2F and
OS for patients treated with HDCT were 31% and 43%, respectively. In
multivariate analysis low Karnofsky performance score at the time of
progression (P < .0001), age above 50 years
(P = .019), and failure to attain a temporary remission
on first-line treatment (P = .0003) were significant
adverse prognostic factors for OS. Patients with none of these risk
factors had a 5-year OS of 55% compared with 0% for patients with all
3 of these unfavorable prognostic factors. Although HDCT is a
reasonable option for selected patients with primary progressive HD,
the majority did not receive HDCT. Interestingly, salvage radiotherapy
gave promising results in patients with localized PD.
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