Yousif Fawaz S, Matti Bassam Francis, Sabir Shahla'a Fadhil, Al-Bakri Zena A, Faraj Safa A, Mohammed Mazin A, Shakir Zahraa S, Khalid Mahmood W, Al Hlali Saba H, Saeb Sarah M
Hematology and Bone Marrow Transplant Center, Bone Marrow Transplant Department, Medical City, Baghdad, Iraq.
Hematology and Bone Marrow Transplant Center, Medical City, Baghdad, Iraq.
Transpl Immunol. 2025 Mar;89:102182. doi: 10.1016/j.trim.2025.102182. Epub 2025 Jan 31.
Autologous stem cell transplantation (ASCT) imposes significant immunogenic effects that may also underlie some of its anti-tumor effectiveness. Despite improvements in disease risk stratification and treatment approaches with high cure and response rate for newly diagnosed Hodgkin lymphoma (HL) with initial therapy in most patients, a significant proportion will be experiencing refractory or relapsed (R/R) following the initial front-line therapy. A high-dose chemotherapy followed by ASCT remains the standard treatment for relapsed Hodgkin disease in adult patients. The aim of our study was to identify the impact of ASCT on outcomes in R/R HL, considering various pre- and post-ASCT parameters as prognostic predictors, including disease status response, time of absolute neutrophils, and lymphocyte recovery counts post ASCT.
We retrospectively investigated data of 118 patients with R/RHL from January 2014 to December 2022, whose ages ranged from 7 to 58 years old. The recorded data included: the early response type and mortality rate, at day 100 post-ASCT, as well as the end of the study outcomes such as survival, relapse, and mortality status. Patients were grouped according to gender, disease status pre-ASCT, number of chemotherapy protocols that were given pre-ASCT, time of absolute neutrophils and lymphocyte recovery counts post-ASCT.
The mean age of our included patients was 25.1 (7-58) years. The male to female ratio was1.2:1with a mean duration of disease follow-up was 74.2 months. The mean duration time of absolute neutrophil and lymphocyte recovery count post-ASCT day was 11 ± 2.9 and 13 ± 2.6 days respectively. The outcome at 100 days post-ASCT was: 89.8 % of the patients showed complete remission, 6.8 % showed no response, and 3.4 % deceased. The three-year overall survival (OS) rate was 88.5 %, while the event free survival (EFS) rate was 72 %. Regarding the three-year EFS rate for patient with complete remission was 91 %, for patients with uncertain complete response was 71 %, also 71 % for partial remission and 45 % for stable disease. The EFS rate in relation to the number of chemotherapy protocols at three-year follow up was 80 % and 66 % for patients with ≥2 chemotherapy lines(P = 0.03).
Autologous stem cell transplantation for R/R HL patients demonstrated a significant favorable outcome in terms of the overall survival rate and the progression-free disease, especially among those who exhibited earlier response to salvage chemotherapy at the pre-transplantation stage and unrelated to time of absolute neutrophil and lymphocyte recovery count.
自体干细胞移植（ASCT）具有显著的免疫原性效应，这可能也是其部分抗肿瘤效果的基础。尽管在疾病风险分层和治疗方法方面有所改进，大多数新诊断的霍奇金淋巴瘤（HL）患者通过初始治疗具有较高的治愈率和缓解率，但仍有相当一部分患者在初始一线治疗后会出现难治或复发（R/R）情况。大剂量化疗后进行ASCT仍然是成年复发霍奇金病患者的标准治疗方法。我们研究的目的是确定ASCT对R/R HL患者预后的影响，将各种ASCT前后参数作为预后预测指标，包括疾病状态反应、绝对中性粒细胞时间以及ASCT后淋巴细胞恢复计数。
我们回顾性研究了2014年1月至2022年12月期间118例R/R HL患者的数据，患者年龄在7至58岁之间。记录的数据包括：ASCT后100天的早期反应类型和死亡率，以及研究结束时的生存、复发和死亡状态等结果。患者根据性别、ASCT前疾病状态、ASCT前接受的化疗方案数量、绝对中性粒细胞时间以及ASCT后淋巴细胞恢复计数进行分组。
我们纳入患者的平均年龄为25.1（7 - 58）岁。男女比例为1.2:1，疾病随访平均时长为74.2个月。ASCT后绝对中性粒细胞和淋巴细胞恢复计数的平均时长分别为11±2.9天和13±2.6天。ASCT后100天的结果为：89.8%的患者完全缓解，6.8%无反应，3.4%死亡。三年总生存率（OS）为88.5%，无事件生存率（EFS）为72%。完全缓解患者的三年EFS率为91%，不确定完全缓解患者为71%，部分缓解患者也为71%，疾病稳定患者为45%。在三年随访中，接受≥2线化疗方案患者的EFS率与化疗方案数量相关，分别为80%和66%（P = 0.03）。
对于R/R HL患者，自体干细胞移植在总生存率和无进展疾病方面显示出显著的良好结果，特别是在移植前阶段对挽救性化疗表现出较早反应的患者中，且与绝对中性粒细胞和淋巴细胞恢复计数时间无关。
