Canterbury DHB

Context

Hodgkin Lymphoma

Autologous SCT (ASCT) in first relapse results in PFS of up to 70% and OS 50-80%. Results are better in patients achieving a second remission although patients with stable disease or minimal response may still have durable remissions. PET scan pre-ASCT can further predict relapse in chemosensitive patients. ASCT is recommended for relapsed or refractory Hodgkin’s disease by British and Italian guideline groups based on two small RCT and non-randomised studies, mostly from single centres (Brusamolino, Bacigalupo et al. 2009; BSBMT 2010). Despite the lack of evidence for a survival benefit, ASCT has become standard practice in order to minimise drug exposure and toxicity of multiple salvage regimens, decrease the chance of failure to harvest PBSC and to avoid QoL issues with multiple relapses. Patients with primary refractory disease or who fail to achieve a response after salvage therapy have a poorer prognosis after ASCT and alternative strategies including novel agents, tandem ASCT and allogeneic SCT should be considered.

Myeloablative allogeneic SCT fell from use in adults due to high non-relapse mortality rates (43-61%). A retrospective analysis of EBMT data for adults found significantly lower NRM and improved OS with RIC. Although RIC allogeneic SCT has been widely adopted due to lower NRM (6-25%) there is no consensus on patient selection and relapse rates remain very high (44-81%). Most studies have been done in patients relapsed post ASCT in the pre-PET era. Although progressive disease often responds to DLI (response rates 35-55%) most studies show relapses in nearly all patients after prolonged follow up (Anderlini, Saliba et al. 2012). Allogeneic transplant is a clinical option in CR>1 or for patients likely to fail ASCT, e.g. CR1 <1 year, PET+ post salvage, less than PR post salvage or chemorefractory.

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About this Canterbury DHB document (8163):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

December 2016

Next Review:

December 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 8163