Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
Ann Hematol. 2020 Feb;99(2):265-276. doi: 10.1007/s00277-019-03900-x. Epub 2020 Jan 2.
Autologous stem cell transplantation (autoSCT) can achieve long-term remission in primary refractory or relapsed Hodgkin lymphoma (r/r HL); however, still up to 50% of patients relapse after autoSCT. In this retrospective analysis, we investigated the impact of autologous stem cell transplantation in a consecutive, unselected cohort of primary refractory and relapsed Hodgkin lymphoma patients (n = 66) with the majority of patients treated in the pre-brentuximab vedotin and immune checkpoint inhibitor era. In our cohort, a 5-year overall survival (OS) from autoSCT of 59.5% and a 5-year progression-free survival (PFS) after autoSCT of 46.1% was achieved. Multivariate analysis revealed primary refractory disease and early relapse (< 12 months) after initial therapy as well as the presence of B symptoms at relapse as independent risk factors associated with a higher risk for relapse and an inferior PFS and OS. Several other clinical factors, including the presence of extranodal disease at relapse and failure to achieve a complete response to salvage chemotherapy, were associated with a trend towards an inferior survival. Patients relapsing after autoSCT had a particularly poor outcome, regardless of eligibility to undergo allogeneic stem cell transplantation (alloSCT). We further evaluated recently published prognostic models for r/r HL patients undergoing autoSCT and could validate several risk scores in our independent "real world" cohort.
自体干细胞移植（autoSCT）可在原发性难治性或复发性霍奇金淋巴瘤（r/r HL）患者中实现长期缓解；然而，仍有多达 50%的患者在 autoSCT 后复发。在这项回顾性分析中，我们调查了自体干细胞移植对连续、未经选择的原发性难治性和复发性霍奇金淋巴瘤患者队列（n=66）的影响，这些患者大多数在 Brentuximab vedotin 和免疫检查点抑制剂时代之前接受治疗。在我们的队列中，autoSCT 后的 5 年总生存率（OS）为 59.5%，autoSCT 后 5 年无进展生存率（PFS）为 46.1%。多因素分析显示，原发性难治性疾病和初始治疗后早期复发（<12 个月）以及复发时存在 B 症状是与更高复发风险、更差的 PFS 和 OS 相关的独立危险因素。其他一些临床因素，包括复发时存在结外疾病和挽救性化疗未能达到完全缓解，与生存率降低呈趋势相关。在接受 autoSCT 后复发的患者，无论是否有资格接受异基因干细胞移植（alloSCT），其预后都特别差。我们进一步评估了最近发表的接受 autoSCT 的 r/r HL 患者的预后模型，并能够在我们独立的“真实世界”队列中验证几个风险评分。
