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Konstantinova et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract63
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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Hematopoietic stem cell transplantation (HSCT) in the treatment of Hodgkin’s lymphoma (HL) patients: Experience in the Sverdlovsk region

Tatiana S. Konstantinova, Elena V. Chepuryaeva, Yulia V. Sveshnikova, Yulia S. Kitaeva, Vladimir A. Shalaev, Aleksandr F. Tomilov, Irina V. Krylova, Leonid N. Sharov, Galina A. Kopylova, Natalya V. Vinogradova

Sverdlovsk Regional Clinical Hospital (SRCH) No1, Ekaterinburg, Russia

Correspondence: Tatiana S. Konstantinova, SRCH No 1, 185, Volgogradskaya st., Ekaterinburg, 620102, Russia, E-mail: kts@spam is badokb1.ru

Abstract

Autologous HSCT (autoHSCT) is one of current treatment options for HL patients with relapse, poor response, and progression of the disease during chemotherapy.

Between 1998 and 2010, 231 HSCTs were performed under the supervision of the SRCH No 1. The patients with HL composed 58 of the 205 patients who underwent autoHSCT (28.3%); 1 of 26 underwent allogeneic HSCT (3.8%).

The objective of the present work was the evaluation of the efficiency of autoHSCT in the treatment of patients with HL at the level of a regional hematological center.

Methods: Within the scope of the present work a register of the HL patients was created, the International Prognostic Index at the moment of diagnosis was counted, and a treatment program for all categories of HL patients was agreed upon, including using of autologous and allogeneic HSCT. Disease-free (DFS) and overall survival (OS) was evaluated.

Results: Two groups of the HL patients with bad disease prognosis according to the International Prognostic Index and to response to their first-line chemotherapy were analyzed: the first group received only standard chemotherapy, including high-dose programs (DHAP, DexaBEAM, gemzar + dexamethason) for the second line, the second group also received autoHSCT. Both groups received radiotherapy on indications after the main chemotherapy and HSCT. In the first group 51 patients with only newly diagnosed disease were analyzed: 27 women (52.9%) and 24 men (47.1%) with a median age of 27 years (range, 16–66); 46 patients (90.2%) with IV–III stage disease, and 5 (9.8%) at disease stage I–II. Complete remission (CR) and partial remission (PR) at completion of chemotherapy was 68.6%. Three-year OS and DFS were 84% and 69% respectively. In the second group 56 patients were analyzed: 26 women (44.4%) and 30 men (53.6%), median age 25 years (range, 15–44): 21 patients (37.5%) with stage IV disease, 18 patients (32.1%) at stage III, and 17 patients (30.4%) at stage II. In this group there were 40 patients (71.4%) with their first disease emergence and 16 patients (28.6%) experiencing their first disease relapse. After the completion of chemotherapy 15 patients (26.7%) entered CR, 27 patients (48.2%) entered PR, 6 patients (10.7%), less than PR, and 8 patients (14.2%) had disease progression. After autoHSCT CR was achieved in 27 patients (48.2%), PR in 26 patients (46.4%), 2 patients (3.6%) still had progression of the disease, and it was too early to evaluate the response in 3 patients. Three-year OS and DFS were 95% and 82% respectively.

Peripheral blood stem cells were used for the transplant in 41 patients (73.2%), and combined transplant material (bone marrow + peripheral blood stem cells) in 15 patients (26.8%). The mean dose of transplanted CD34+ cells was 7.8±2.0x106/kg (range, 0.21–18x106/kg). Conditioning was performed with the BEAM protocol and very seldom with CVB. In general, the transplant was collected after stimulation with granulocyte colony-stimulating factors only. Average time of granulocyte recovery (>0.5x109/л) was 16±3 days (range, 8–56), and platelet recovery (50x109/l), 20±5 days (range, 25–68). Early mortality after HSCT was 0%.

Conclusions: Three-year OS and DFS of the high-risk HL patients who underwent autoHSCT are better than after chemotherapy only (95% vs. 84%, p=0.05 and 82% vs. 69%, p=0.05, respectively). The use of HSCT technologies for HL treatment is reasonable and replicable at the level of a regional hematological center.

Keywords: Hodgkin’s lymphoma, HSCT, overall survival, disease-free survival

 

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