Risk factors predicting outcomes among primary refractory disease patients

This study determined whether certain risk factors predicted outcomes in primary refractory Hodgkin lymphoma. The authors concluded that risk factors such as stage IV disease and cancer activity seen on imaging predicted worse overall outcomes.

Refractory disease  Hodgkin lymphoma patients are those who are do not respond to first-line treatment. Second-line treatment includes salvage chemotherapy (a second course) followed by high-dose chemotherapy and stem cell (immature blood cell) transplantation. This is only successful in 40-50% of patients.
 
Patients with cancer-positive, post-salvage therapy imaging scans often have lower survival rates. In a group of relapsed and refractory disease patients, specific risk factors have also predicted lower survival. Whether refractory disease patients alone have the same risk factors remains unclear.

This study examined risk factors for survival in primary refractory disease (PRD) patients alone. PRD patients were those with either disease progression or a lack of a complete response one month after initial therapy. The study determined whether certain risk factors predicted treatment response and survival. This study included 192 patients. 167 of these received full treatment (the transplanted group). 87% of patients were treated with ICE (ifosfamide, carboplatin, etoposide)-based salvage therapy. 65.6% were treated with radiation. Event-free survival (EFS) was survival from two different specified dates to disease-progression, death (any cause) without progression, or last follow-up. Overall survival (OS) was the time from the same dates to death or last follow-up. 

41% of all patients had cancer-positive scans after salvage treatments. The average EFS was 8.9 years and the average OS 10.4 years. Patients with bulky disease (tumors greater than 5 cm) were 2.03 times more likely to have cancer-positive scans. Patients with B symptoms (weight loss, fever and excessive sweating) were 2.15 times more likely.

31% of the transplanted group had cancer-positive scans. Three-year EFS rates were 84% in patients without additional risk factors. The rate was 54% for patients with stage IV disease 28% for those with cancer-positive scans.

The authors concluded that stage IV disease and cancer-positive imaging scans were risk factors that predicted worse overall outcomes in refractory-disease patients.

Prospective trials are needed.