High dose chemoradiotherapy and ASCT may overcome the prognostic importance of biologic markers in relapsed/refractory Hodgkin lymphoma Journal Article


Authors: Persky, D. O.; Moskowitz, C. H.; Filatov, A.; Saxena, R.; Cui, H.; Teruya-Feldstein, J.
Article Title: High dose chemoradiotherapy and ASCT may overcome the prognostic importance of biologic markers in relapsed/refractory Hodgkin lymphoma
Abstract: INTRODUCTION: Of about 20% of patients with relapsed/refractory Hodgkin lymphoma (HL), approximately half achieve long-term remissions after high-dose chemoradiotherapy and autologous stem cell transplantation (HDT/ASCT). Treatment with a comprehensive program using second-line chemotherapy with ICE (ifosfamide, carboplatin, etoposide) before HDT/ASCT identified a clinical prognostic model, but prognostic biologic markers in relapsed/refractory HL remain unclear. We sought to determine if we could identify such markers, and if our comprehensive second-line program could overcome their significance. METHODS: Pre-ICE biopsy specimens of 191 patients enrolled on 1 of 2 Institutional Review Board-approved clinical trials of HDT/ASCT. We performed immunohistochemistry staining for Bcl-2, Bax, Bim, p53, and interleukin-6. Samples were considered positive if more than 10% of Hodgkin Reed-Sternberg cells stained at any intensity. RESULTS: Ninety-one patients had sufficient tissue available. Forty-eight patients (53%) had an event and 36 (40%) died. Median event-free survival (EFS) was 8.5 years, median overall survival (OS) was not reached, and median follow-up was 8.8 years. Bcl-2 was overexpressed in 37/91 (41%), Bax in 28/65 (43%), Bim in 9/72 (13%), p53 in 38/89 (43%), and interleukin-6 in 58/84 (69%) patients. Overexpression of these biomarkers had no statistically significant association with EFS or OS, except for association of Bim overexpression with inferior OS (P=0.0385). The 3-factor clinical model (B symptoms at relapse, extranodal disease, and complete remission duration of <1 y) remained highly significant (0/1 vs. 2/3 factors) for EFS and OS (P=0.0008 and P=0.0001, respectively). CONCLUSIONS: Despite the evidence that p53 and Bcl-2 overexpression may predict a worse prognosis with initial treatment, it seems that at relapse such overexpression is either not prognostically significant, or that the treatment with ICE and HDT/ASCT overcomes its significance. Subsequent studies should further address the role of Bim in both initial and relapsed/refractory settings. Copyright © 2009 by Lippincott Williams & Wilkins.
Keywords: immunohistochemistry; adolescent; adult; cancer chemotherapy; cancer survival; controlled study; event free survival; human tissue; protein expression; aged; middle aged; young adult; major clinical study; proto-oncogene proteins; salvage therapy; cancer risk; cancer radiotherapy; combined modality therapy; drug megadose; follow up; biomarkers; biological marker; carboplatin; protein bcl 2; etoposide; tumor markers, biological; bim protein; apoptosis regulatory proteins; membrane proteins; autologous stem cell transplantation; tumor biopsy; hematopoietic stem cell transplantation; protein p53; cancer mortality; ifosfamide; hodgkin disease; cancer regression; interleukin 6; tumor suppressor protein p53; cancer relapse; proto-oncogene proteins c-bcl-2; transplantation, autologous; chemoradiotherapy; reed sternberg cell; protein bax; autologous stem cell transplant (asct); relapsed/refractory hodgkin lymphoma
Journal Title: Applied Immunohistochemistry & Molecular Morphology
Volume: 18
Issue: 1
ISSN: 1541-2016
Publisher: Lippincott Williams & Wilkins  
Date Published: 2010-01-01
Start Page: 35
End Page: 40
Language: English
DOI: 10.1097/PAI.0b013e3181b473b7
PUBMED: 19701081
PROVIDER: scopus
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "CODEN: AIMMF" - "Source: Scopus"
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MSK Authors
  1. Daniel Oscar Persky
    10 Persky
  2. Craig Moskowitz
    392 Moskowitz
  3. Julie T Feldstein
    292 Feldstein
  4. Rakhee Saxena
    2 Saxena