Immune reconstitution with high-dose chemotherapy and autologous stem cell transplantation in refractory and relapsed Hodgkin lymphoma: Prognostic factors and outcome from a single-center experience

Abstract

Background: Autologous stem cell transplantation (ASCT) imposes significant immunogenic effects that may also underlie some of its anti-tumor effectiveness. Despite improvements in disease risk stratification and treatment approaches with high cure and response rate for newly diagnosed Hodgkin lymphoma (HL) with initial therapy in most patients, a significant proportion will be experiencing refractory or relapsed (R/R) following the initial front-line therapy. A high-dose chemotherapy followed by ASCT remains the standard treatment for relapsed Hodgkin disease in adult patients. The aim of our study was to identify the impact of ASCT on outcomes in R/R HL, considering various pre- and post-ASCT parameters as prognostic predictors, including disease status response, time of absolute neutrophils, and lymphocyte recovery counts post ASCT.

Methods: We retrospectively investigated data of 118 patients with R/RHL from January 2014 to December 2022, whose ages ranged from 7 to 58 years old. The recorded data included: the early response type and mortality rate, at day 100 post-ASCT, as well as the end of the study outcomes such as survival, relapse, and mortality status. Patients were grouped according to gender, disease status pre-ASCT, number of chemotherapy protocols that were given pre-ASCT, time of absolute neutrophils and lymphocyte recovery counts post-ASCT.

Results: The mean age of our included patients was 25.1 (7-58) years. The male to female ratio was1.2:1with a mean duration of disease follow-up was 74.2 months. The mean duration time of absolute neutrophil and lymphocyte recovery count post-ASCT day was 11 ± 2.9 and 13 ± 2.6 days respectively. The outcome at 100 days post-ASCT was: 89.8 % of the patients showed complete remission, 6.8 % showed no response, and 3.4 % deceased. The three-year overall survival (OS) rate was 88.5 %, while the event free survival (EFS) rate was 72 %. Regarding the three-year EFS rate for patient with complete remission was 91 %, for patients with uncertain complete response was 71 %, also 71 % for partial remission and 45 % for stable disease. The EFS rate in relation to the number of chemotherapy protocols at three-year follow up was 80 % and 66 % for patients with ≥2 chemotherapy lines(P = 0.03).

Conclusion: Autologous stem cell transplantation for R/R HL patients demonstrated a significant favorable outcome in terms of the overall survival rate and the progression-free disease, especially among those who exhibited earlier response to salvage chemotherapy at the pre-transplantation stage and unrelated to time of absolute neutrophil and lymphocyte recovery count.

Keywords: Autologous stem cell transplantation; Hodgkin lymphoma; Overall survival; Refractory; Relapse.