High-dose chemo-radiotherapy for relapsed or refractory Hodgkin lymphoma and the significance of pre-transplant functional imaging: Research paper Journal Article
| Authors: | Moskowitz, C. H.; Yahalom, J.; Zelenetz, A. D.; Zhang, Z.; Filippa, D.; Teruya-Feldstein, J.; Kewalramani, T.; Moskowitz, A. J.; Rice, R.; Maragulia, J.; Vanak, J.; Trippett, T.; Hamlin, P.; Horwitz, S.; Noy, A.; O'Connor, O. A.; Portlock, C.; Straus, D.; Nimer, S. D. |
| Article Title: | High-dose chemo-radiotherapy for relapsed or refractory Hodgkin lymphoma and the significance of pre-transplant functional imaging: Research paper |
| 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. © 2010 Blackwell Publishing Ltd. |
| Keywords: | adolescent; adult; cancer chemotherapy; controlled study; event free survival; treatment outcome; treatment response; aged; middle aged; young adult; major clinical study; salvage therapy; dose response; cancer radiotherapy; radiotherapy, adjuvant; neoplasm staging; carboplatin; computer assisted tomography; etoposide; antineoplastic combined chemotherapy protocols; recurrence; tomography, x-ray computed; autologous stem cell transplantation; hematopoietic stem cell transplantation; ifosfamide; hodgkin disease; pneumonia; epidemiologic methods; positron-emission tomography; cancer relapse; hodgkin lymphoma; high-dose chemoradiotherapy; hsct; septic shock |
| Journal Title: | British Journal of Haematology |
| Volume: | 148 |
| Issue: | 6 |
| ISSN: | 0007-1048 |
| Publisher: | John Wiley & Sons |
| Date Published: | 2010-03-01 |
| Start Page: | 890 |
| End Page: | 897 |
| Language: | English |
| DOI: | 10.1111/j.1365-2141.2009.08037.x |
| PUBMED: | 20085577 |
| PROVIDER: | scopus |
| PMCID: | PMC3920913 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: BJHEA" - "Source: Scopus" |
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