Tandem Autologous Stem Cell Transplantation for Patients with Primary Progressive or Rapidly Relapsing Hodgkin’s Disease.
Authors: Bolwell Brian , Pohlman Brad , Sobecks Ronald , Andresen Steven , Rybicki Lisa , Brown Stacey , Kuczkowski Elizabeth , Bates Jennifer , Bernhard Laura , Cherni Kelly , Baker Janet , Kalaycio Matt 
Published: April 2020

High dose chemotherapy and autologous stem cell transplantation (ABMT) is the treatment of choice for most patients with recurrent Hodgkin’s Disease (HD). Cure rates approach 50% for patients with favorable prognostic features, but ABMT salvages only approximately 20% of patients with very high-risk features. Such patients include those who progress through initial chemotherapy, and those relapsing rapidly after initial chemotherapy. Traditional ablative allogeneic transplantation has not improved the outcome for such high-risk patients, largely because of high transplant-related mortality. Non-myeloablative allogeneic transplantation may have a role for patients with less malignant HD and is currently under study. Tandem autologous transplantation may prove to be superior for such high-risk HD patients, analogous to data seen in multiple myeloma. This study represents a summary of all 15 high-risk HD patients treated with a tandem autologous approach at our institution. Patients were treated from 11/6/02–6/7/05 with a median follow-up of survivors of 8.9 months (range, 0.9–27.8 months). Eligibility into this study included disease progression during initial chemotherapy or relapse within one year of initial chemotherapy. Patients received etoposide plus G-CSF for stem cell mobilization with a minimum of 4 x 106 CD34+ cells/kg collected. The first transplant was with single agent Melphalan (150 mg/m2). After an interval of 4–8 weeks, the second transplant consisted of BCNU, etoposide and cyclophosphamide (CBV). 15 patients have been entered into the study, median age 29 years. 20% had prior radiation therapy; all had failed prior chemotherapy, 14/15 had been treated with ABVD and 1 had Stanford V. 66% had a response (usually partial) to salvage chemotherapy and 33% did not. Median number of days from the 1st transplant to the 2nd transplant was 46 days. Median CD34+ cell dose collected was 18.3 x 106 cells/kg (range, 4.49–29.04). 100% of patients completed the planned treatment. 100-day survival was 100%. To date, 40% have relapsed and 60% are disease free. Of relapsing patients, median time from the 2nd transplant to relapse was 100 days (range, 44–491 days). The overall survival curve is shown below:

Figure Figure

We retrospectively identified 18 comparable high-risk HD patients who had previously received a single autologous transplant at our institution from 1988 to 2003. The relapse rate post ABMT for these patients was 67%. Median time to relapse was 5.8 months (range, 1.5–45.4 months). In conclusion, we believe that tandem autologous transplantation is promising for very high-risk HD patients. Of those patients destined to relapse after tandem transplant, the majority do so within 6 months of therapy. Therefore, a rather short follow-up is still indicative of favorable results, given that the majority of treated patients on this trial are currently alive and disease free.