Disease status and stem cell source impact on the results of reduced intensity conditioning transplant for Hodgkin lymphoma: a retrospective study from the French Society of Bone Marrow Graft Transplantation and Cellular Therapy.
Résumé
The role of reduced intensity allogeneic stem cell transplantation for the treatment of relapsed/refractory Hodgkin lymphoma remains controversial. We retrospectively analyzed 191 patients who underwent reduced intensity allogeneic stem cell transplantation between 1998 and 2008 for relapsed or refractory Hodgkin lymphoma and whose data were reported to the French registry. Median follow-up was 36 months. Estimated 3 years overall survival, progression free survival, cumulative incidence of relapse and cumulative incidence of non relapse mortality were 63%, 39%, 46%, and 16% respectively. There was no difference in outcome between patients in complete response and in partial response at time of transplantation for overall survival (70% versus 74%, no significant difference) and progression free survival (51% versus 42%, no significant difference). Patients with chemoresistant disease had a shorter overall survival (39% at 3 years p=0.0003) and progression free survival (18% at 3 years p=0.001) than patients in complete remission. The use of umbilical cord blood as stem cell source was associated with a poor outcome with an increased risk of death with a hazard ratio of 3.49 (95% confidence interval 1.26 to 9.63, p=0.016). The use of peripheral blood was associated with a better outcome for patients who where alive after 1 year post transplantation with a hazard ration of 0.38 (95% confidence interval 0.17 to 0.83, p=0.016). Disease status at transplantation remains the most important risk factor for outcome. Our data suggest that the use of peripheral blood should be preferred whereas umbilical cord blood should be used with caution.