Long-term survival and late relapse in 2-year survivors of autologous haematopoietic cell transplantation for Hodgkin and non-Hodgkin lymphoma

Abstract

This study described long-term outcomes of autologous haematopoietic-cell transplantation (HCT) for advanced Hodgkin (HL) and non-Hodgkin lymphoma (NHL). The study included recipients of autologous HCT for HL (N = 407) and NHL (N = 960) from 1990-98 who were in continuous complete remission for at least 2 years post-HCT. Median follow-up was 104 months for HL and 107 months for NHL. Overall survival at 10-years was 77% (72-82%) for HL, 78% (73-82%) for diffuse large-cell NHL, 77% (71-83%) for follicular NHL, 85% (75-93%) for lymphoblastic/Burkitt NHL, 52% (37-67%) for mantle-cell NHL and 77% (67-85%) for other NHL. On multivariate analysis, mantle-cell NHL had the highest relative-risk for late mortality [2.87 (1.70-4.87)], while the risks of death for other histologies were comparable. Relapse was the most common cause of death. Relative mortality compared to age, race and gender adjusted normal population remained significantly elevated and was 14.8 (6.3-23.3) for HL and 5.9 (3.6-8.2) for NHL at 10-years post-HCT. Recipients of autologous HCT for HL and NHL who remain in remission for at least 2-years have favourable subsequent long-term survival but remain at risk for late relapse. Compared to the general population, mortality rates continue to remain elevated at 10-years post-transplantation.

Fig 1

Overall survival of patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for lymphoma: (A) Diffuse large cell, follicular and mantle cell lymphomas (B) Burkitt, Hodgkin and other lymphomas

Fig 1

Overall survival of patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for lymphoma: (A) Diffuse large cell, follicular and mantle cell lymphomas (B) Burkitt, Hodgkin and other lymphomas

Fig 2

Disease-free survival of patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for lymphoma: (A) Diffuse large cell, follicular and mantle cell lymphomas (B) Burkitt, Hodgkin and other lymphomas

Fig 2

Disease-free survival of patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for lymphoma: (A) Diffuse large cell, follicular and mantle cell lymphomas (B) Burkitt, Hodgkin and other lymphomas

Fig 3

Relapse among patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for lymphoma: (A) Diffuse large cell, follicular and mantle cell lymphomas (B) Burkitt’ Hodgkin and other lymphomas

Fig 3

Relapse among patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for lymphoma: (A) Diffuse large cell, follicular and mantle cell lymphomas (B) Burkitt’ Hodgkin and other lymphomas

Fig 4

Non-relapse mortality among patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for lymphoma: (A) Diffuse large cell, follicular and mantle cell lymphomas (B) Burkitt, Hodgkin and other lymphomas

Fig 4

Non-relapse mortality among patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for lymphoma: (A) Diffuse large cell, follicular and mantle cell lymphomas (B) Burkitt, Hodgkin and other lymphomas

Fig 5

Cumulative incidence of relapse at additional 5-years for patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant. The x-axis denotes the number of years in complete remission post-transplant. The line within each box indicates the cumulative incidence of relapse over the next 5-years of followup and the ends represent 95% confidence intervals.

Fig 6

A & B. Relative excess mortality (solid line) compared to age-, gender- and race- matched general population for patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for (A) Hodgkin lymphoma and (B) non-Hodgkin lymphoma. A relative risk of 1 indicates that the mortality rate of the population of interest is similar to that of the general population. Dashed lines represent 95% confidence intervals. The P-value testing the hypothesis that the relative mortality is greater than 1 was <0.05.

Fig 6

A & B. Relative excess mortality (solid line) compared to age-, gender- and race- matched general population for patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for (A) Hodgkin lymphoma and (B) non-Hodgkin lymphoma. A relative risk of 1 indicates that the mortality rate of the population of interest is similar to that of the general population. Dashed lines represent 95% confidence intervals. The P-value testing the hypothesis that the relative mortality is greater than 1 was <0.05.