Conditioning Regimens Prior to Autologous Hematopoietic Stem Cell Transplantation in Patients with Relapsed/Refractory Classical Hodgkin Lymphoma
Abstract
Aim
To analyze the efficacy of various high-dose chemotherapy (HDCT) regimens with autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with relapsed/refractory classical Hodgkin lymphoma (r/r cHL). MATERIALS &
Methods
The study enrolled 356 r/r cHL patients treated at the NN Blokhin National Medical Cancer Research Center from 1996 to 2025. The primary refractory course was reported in 54.8 % of patients. At the time of auto-HSCT, the median age of patients was 30.6 years. Prior to auto-HSCT, most of them (51.5 %) received standard second-line polychemotherapy (PCT), whereas 48.6 % of patients were treated with targeted drugs or/and immune checkpoint inhibitors (ICIs) either as monotherapy or combined with PCT. Prior to auto-HSCT, most patients showed chemotherapy-sensitive disease (78 %). Conditioning regimens included BEAM (43 %), LEAM (35 %), as well as other regimens (Mito-L/PAM, BeEAM, BeEAC, NEAM, Mito-CBV, VpMelTBI, CEAC, CBV, and Mel) in 22 % of cases.
Results
The immediate efficacy was as follows: complete remission (CR) was achieved in 68.8 % and partial remission in 10.0 % of patients, stable disease was reported in 6.5 % and relapse or progression in 14.0 % of patients. Mortality from treatment toxicity within the first year after auto-HSCT was 2.5 %. Over a 3-year period, the total cohort showed the relapse rate of 31.0 %, overall survival (OS) rate of 85.2 %, progression-free and event-free survival rates of 68.2 % and 60.0 %, respectively. The analysis of the short- and long-term outcomes in relation to HDCT regimens revealed the best rates achieved by the LEAM program. However, the multivariate regression analysis excluded the value of HDCT regimens for OS in r/r cHL. The analysis revealed such OS criteria as administration of new drugs (targeted agents or/and ICIs) prior to auto-HSCT and achieving CR at the time of auto-HSCT. By regression analysis, administration of new drugs prior to auto-HSCT reduces mortal probability by 68 %, whereas achieving CR prior to auto-HSCT improves OS rates by 59 %. In patients with CR, the 3-year OS was 94 %.
Conclusion
The choice of HDCT regimen had no significant effect on the OS rates. Targeted drugs or/and ICIs along with CR achieved prior to auto-HSCT significantly improve long-term outcomes of r/r cHL treatment.