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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MSK Authors
  1. Zhigang Zhang
    241 Zhang
  2. Joachim Yahalom
    404 Yahalom
  3. Carol Portlock
    180 Portlock
  4. Craig Moskowitz
    374 Moskowitz
  5. Ariela Noy
    206 Noy
  6. Julie T Feldstein
    288 Feldstein
  7. Steven M Horwitz
    360 Horwitz
  8. Andrew D Zelenetz
    554 Zelenetz
  9. Stephen D Nimer
    345 Nimer
  10. Alison Moskowitz
    147 Moskowitz
  11. Paul Hamlin
    173 Hamlin
  12. Jill M Vanak
    14 Vanak
  13. Daniel A Filippa
    102 Filippa
  14. David J Straus
    213 Straus
  15. Robert D Rice
    27 Rice