Risk factors for relapse after autologous stem cell transplantation

The authors looked at several risk factors that may be associated with relapse after autologous stem cell transplantation (ASCT). The authors found that 5 risk factors were independently associated with relapse after ASCT: stage IV cancer before ASCT; less than 3 months between previous treatment and relapse; performance status of 1 or higher; tumor bulk of 5 cm or more; and no partial response after salvage chemotherapy.

Hodgkin lymphoma is generally considered a curable disease. However, some patients will relapse or not respond to first- or second-line therapy. These patients generally undergo autologous stem cell transplantations (ASCT) using stem cells from their own bodies.

If ASCT fails, It is very important to start patients on more aggressive treatment as soon as possible. Therefore, it is important to be able to predict who is most at risk for relapse after ASCT. Previous studies have suggested possible risk factors, but no study has looked at more than one risk factor at a time. 

This study considered 20 different risk factors together to determine which were best at predicting whether patients will relapse after ASCT. 

The medical records of 656 patients were reviewed. The average follow-up time was 60 months after receiving ASCT. This first group was used to identify risk factors that may be associated with a patient relapsing after ASCT. 

The medical records of an additional 389 patients were then reviewed. The average follow-up time was 59 months after ASCT. This second group was used to test whether the risk factors identified in the first group were able to predict if a patient would relapse after ASCT.

20 potential risk factors were compared in the first group. Five risk factors were identified that predicted which patients had the highest risk of relapsing after ASCT. These risk factors were:

• Stage IV disease before ASCT
• Less than 3 months between previous treatment and relapse
• Performance status (ability to function in life, on a scale of 0 [fully active] to 4 [bedbound]) of 1 or higher
• Tumor bulk of 5 cm or more
• Inadequate response to salvage (treatment after initial treatment failure) therapy (less than partial response)

The risk factors identified in group 1 were able to identify with good accuracy which patients in group 2 were more likely to relapse following ASCT. 

The authors concluded that there are 5 main risk factors that can predict which patients are at greatest risk for relapse after receiving an autologous stem cell transplantation.