In a nutshell
Some Hodgkin lymphoma patients either do not respond to treatment (refractory disease) or relapse soon afterwards. These patients can be treated with high-dose chemo-radiotherapy, followed by stem-cell surgery. This approach, however, only cures 40-50% of patients.
There are three major risk factors predicting poorer outcomes in these patients. These are: tumors located outside the lymphatic system; initial remission lasting less than one year; and the presence of weight loss, excessive sweating and fever.
When patients receive salvage therapy (a second course of chemotherapy before high-dose chemotherapy) with ICE (ifosfamide, carboplatin and etoposide), five-year event-free survival (EFS; time from treatment until an event such as disease progression) is 55%. These rates vary (76%, 35% and 8%) depending on the number of major risk factors the patients have. It is not clear whether adjusting salvage therapy based on the number of risk factors could improve outcomes.
Methods & findings
This study examined whether patient survival improved if salvage therapy was adjusted to individual risk level.
This study examined 105 patients with relapsed- (55%) or refractory disease (45%). All patients received salvage chemotherapy with ICE (two cycles). The intensity of the therapy depended on the number of risk-factors (0-3) the patient had. All patients had functional imaging scans after the therapy. Scans were either positive ( showing cancer activity) or negative (showing no cancer activity). Patients were followed for an average of 7 years.
18% of patients had 0 risk factors. 27% had 1 risk factor. 41% had 2 risk factors and 14% had 3 risk factors. There were no treatment-related deaths. 10.5% of patients failed salvage therapy.
Four-year overall survival (time from treatment until death from any cause) was 72% and four-year EFS was 56%. 90% of patients were sensitive to the salvage chemotherapy. In these patients, 4-year overall survival was 79%, and 4-year EFS was 63%. There was no difference in rates between the risk groups.
Patients with negative scans after salvage therapy were 4.61-fold more likely to have a better 4-year EFS than patients with positive scans, regardless of risk level. The 4-year EFS for negative scans was 77%. This was compared to 33% for positive scans.
The bottom line
The authors concluded that treating patients based on their number of risk factors improved outcomes. This study also concluded that those with cancer-free scans after risk-adapted salvage therapy had better survival outcomes than those with cancer activity after the therapy.
The fine print
Larger studies are needed.
Published By :
British Journal of Haematology
Mar 01, 2010
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