Adolescents and young adults with Hodgkin lymphoma (HL) represent a unique patient population, facing cancer and the toxicities of therapy during an important, transformative period of their lives. The long term outcomes of AYA undergoing intensive chemotherapy and autologous stem cell transplantation (ASCT), both medical and psychosocial, have not been well studied. We assessed the outcome of AYAs undergoing ASCT to define the results of treatment, and assemble a cohort in which we can evaluate the effect of treatment for relapsed disease on personal developmental and psychological outcomes.
Between 1988 and 2009, 181 AYAs (median age 24, range 15–30y) with relapsed or refractory HL received salvage therapy followed by ASCT at Princess Margaret Hospital (PMH) and the Hospital For Sick Children (HSC). Patient characteristics: M:F 94:87; advanced stage (IIB-IV) at diagnosis 84%; first progression or relapse: 90%. All patients had complete or partial response to 2–3 cycles salvage chemotherapy (platinum-base, mini-BEAM or ifosfamide-vinorelbine), and underwent bone marrow harvest (n=83) or stem cell mobilization with chemotherapy and filgrastim (n=98). Intensive therapy: etoposide + melphalan (PMH) or cyclophosphamide, carmustine + etoposide (HSC). Patients with disease bulk >5cm at relapse received post-ASCT involved field radiation if tissue tolerance allowed.
After a median follow-up of surviving patients of 4 years (maximum 16 years), of 181 pts, there have been 105 events for progression-free survival (PFS) and 81 deaths. PFS at 5 years is 41% +/−4% (+/− standard error) and at 10 years is 36% +/−4% (median 1.6 years). Overall survival is 52% +/−5% at 5 years and 39% +/− 5% at 10 years(median 5.6 years). There have been no HL relapses beyond 39 months post-ASCT. Twenty patients (11%) died from treatment related-toxicity (10), second malignancies (5 AML, 2 NHL, 1 lung cancer) or unknown causes (2). Nine patients received an allogeneic stem cell transplant for relapse; 8 have died from progressive HL or treatment-related toxicity and one is alive in relapse.
While highlighting the clear need for improved strategies for disease control for AYAs undergoing ASCT, this analysis has provided a cohort of patients in which to evaluate the long-term impact of intensive therapy on personal and social adjustment, and to identify opportunities for psychosocial intervention and health promotion.
Kuruvilla: Hoffman LaRoche: Honoraria, Research Funding; Celgene: Research Funding; Amgen: Honoraria; Otsuka: Honoraria; Genzyme: Honoraria. Kukreti: Celgene: Honoraria.
Asterisk with author names denotes non-ASH members.