Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease: The 21-year seattle experience

Jeanne E. Anderson, Mark R Litzow, Frederick R. Appelbaum, Gary Schoch, Lloyd D. Fisher, C. Dean Buckner, Finn B. Petersen, Stephen W. Crawford, Oliver W. Press, Jean E. Sanders, William I. Bensinger, Paul J. Martin, Rainer Storb, Keith M. Sullivan, John A. Hansen, E. Donnall Thomas

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Abstract

Purpose: To analyze results of 127 patients undergoing myeloablative therapy followed by marrow transplantation for relapsed or refractory Hodgkin's disease. Patients and Methods: Twenty-three patients had primary refractory disease, 34 were in early first relapse or second complete remission (CR), and 70 had refractory first relapse or disease beyond second CR. Preparative regimens included total-body irradiation (TBI) and chemotherapy (n = 61) or chemotherapy only (n = 66). Sixty-eight patients received autologous marrow, six syngeneic marrow, and 53 allogeneic marrow. Results: The 5-year actuarial probabilities of survival, event-free survival (EFS), relapse, and nonrelapse mortality for the entire group were 21%, 18%, 65%, and 49%, respectively. HLA-identical allogeneic marrow recipients had a statistically lower relapse rate compared with recipients of autologous marrow, but survival, EFS, and nonrelapse mortality rates were not significantly different. In the multivariate analysis, higher performance status and absence of bulky disease predicted for improved EFS and lower relapse rates, while fewer prior treatment regimens predicted for improved EFS and lower nonrelapse mortality rates. Additionally, the univariate analysis showed that patients who underwent transplantation with disease refractory to chemotherapy or beyond second CR had a worse outcome compared with those who had less advanced disease. Conclusion: Outcome with transplantation for patients with Hodgkin's disease is improved if transplantation is performed early after relapse when disease burden is less, tumor chemosensitivity is greater, and the patient is likely to have a better performance status. The use of HLA-matched sibling marrow results in a lower relapse rate and, thus, for some individuals, may be preferable to the use of autologous marrow.

Original languageEnglish (US)
Pages (from-to)2342-2350
Number of pages9
JournalJournal of Clinical Oncology
Volume11
Issue number12
StatePublished - 1993
Externally publishedYes

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Autologous Transplantation
Hodgkin Disease
Bone Marrow
Recurrence
Disease-Free Survival
Transplantation
Drug Therapy
Mortality
Survival
Status Epilepticus
Whole-Body Irradiation
Siblings
Multivariate Analysis
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Anderson, J. E., Litzow, M. R., Appelbaum, F. R., Schoch, G., Fisher, L. D., Dean Buckner, C., ... Donnall Thomas, E. (1993). Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease: The 21-year seattle experience. Journal of Clinical Oncology, 11(12), 2342-2350.

Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease : The 21-year seattle experience. / Anderson, Jeanne E.; Litzow, Mark R; Appelbaum, Frederick R.; Schoch, Gary; Fisher, Lloyd D.; Dean Buckner, C.; Petersen, Finn B.; Crawford, Stephen W.; Press, Oliver W.; Sanders, Jean E.; Bensinger, William I.; Martin, Paul J.; Storb, Rainer; Sullivan, Keith M.; Hansen, John A.; Donnall Thomas, E.

In: Journal of Clinical Oncology, Vol. 11, No. 12, 1993, p. 2342-2350.

Research output: Contribution to journalArticle

Anderson, JE, Litzow, MR, Appelbaum, FR, Schoch, G, Fisher, LD, Dean Buckner, C, Petersen, FB, Crawford, SW, Press, OW, Sanders, JE, Bensinger, WI, Martin, PJ, Storb, R, Sullivan, KM, Hansen, JA & Donnall Thomas, E 1993, 'Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease: The 21-year seattle experience', Journal of Clinical Oncology, vol. 11, no. 12, pp. 2342-2350.
Anderson, Jeanne E. ; Litzow, Mark R ; Appelbaum, Frederick R. ; Schoch, Gary ; Fisher, Lloyd D. ; Dean Buckner, C. ; Petersen, Finn B. ; Crawford, Stephen W. ; Press, Oliver W. ; Sanders, Jean E. ; Bensinger, William I. ; Martin, Paul J. ; Storb, Rainer ; Sullivan, Keith M. ; Hansen, John A. ; Donnall Thomas, E. / Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease : The 21-year seattle experience. In: Journal of Clinical Oncology. 1993 ; Vol. 11, No. 12. pp. 2342-2350.
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abstract = "Purpose: To analyze results of 127 patients undergoing myeloablative therapy followed by marrow transplantation for relapsed or refractory Hodgkin's disease. Patients and Methods: Twenty-three patients had primary refractory disease, 34 were in early first relapse or second complete remission (CR), and 70 had refractory first relapse or disease beyond second CR. Preparative regimens included total-body irradiation (TBI) and chemotherapy (n = 61) or chemotherapy only (n = 66). Sixty-eight patients received autologous marrow, six syngeneic marrow, and 53 allogeneic marrow. Results: The 5-year actuarial probabilities of survival, event-free survival (EFS), relapse, and nonrelapse mortality for the entire group were 21{\%}, 18{\%}, 65{\%}, and 49{\%}, respectively. HLA-identical allogeneic marrow recipients had a statistically lower relapse rate compared with recipients of autologous marrow, but survival, EFS, and nonrelapse mortality rates were not significantly different. In the multivariate analysis, higher performance status and absence of bulky disease predicted for improved EFS and lower relapse rates, while fewer prior treatment regimens predicted for improved EFS and lower nonrelapse mortality rates. Additionally, the univariate analysis showed that patients who underwent transplantation with disease refractory to chemotherapy or beyond second CR had a worse outcome compared with those who had less advanced disease. Conclusion: Outcome with transplantation for patients with Hodgkin's disease is improved if transplantation is performed early after relapse when disease burden is less, tumor chemosensitivity is greater, and the patient is likely to have a better performance status. The use of HLA-matched sibling marrow results in a lower relapse rate and, thus, for some individuals, may be preferable to the use of autologous marrow.",
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T1 - Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease

T2 - The 21-year seattle experience

AU - Anderson, Jeanne E.

AU - Litzow, Mark R

AU - Appelbaum, Frederick R.

AU - Schoch, Gary

AU - Fisher, Lloyd D.

AU - Dean Buckner, C.

AU - Petersen, Finn B.

AU - Crawford, Stephen W.

AU - Press, Oliver W.

AU - Sanders, Jean E.

AU - Bensinger, William I.

AU - Martin, Paul J.

AU - Storb, Rainer

AU - Sullivan, Keith M.

AU - Hansen, John A.

AU - Donnall Thomas, E.

PY - 1993

Y1 - 1993

N2 - Purpose: To analyze results of 127 patients undergoing myeloablative therapy followed by marrow transplantation for relapsed or refractory Hodgkin's disease. Patients and Methods: Twenty-three patients had primary refractory disease, 34 were in early first relapse or second complete remission (CR), and 70 had refractory first relapse or disease beyond second CR. Preparative regimens included total-body irradiation (TBI) and chemotherapy (n = 61) or chemotherapy only (n = 66). Sixty-eight patients received autologous marrow, six syngeneic marrow, and 53 allogeneic marrow. Results: The 5-year actuarial probabilities of survival, event-free survival (EFS), relapse, and nonrelapse mortality for the entire group were 21%, 18%, 65%, and 49%, respectively. HLA-identical allogeneic marrow recipients had a statistically lower relapse rate compared with recipients of autologous marrow, but survival, EFS, and nonrelapse mortality rates were not significantly different. In the multivariate analysis, higher performance status and absence of bulky disease predicted for improved EFS and lower relapse rates, while fewer prior treatment regimens predicted for improved EFS and lower nonrelapse mortality rates. Additionally, the univariate analysis showed that patients who underwent transplantation with disease refractory to chemotherapy or beyond second CR had a worse outcome compared with those who had less advanced disease. Conclusion: Outcome with transplantation for patients with Hodgkin's disease is improved if transplantation is performed early after relapse when disease burden is less, tumor chemosensitivity is greater, and the patient is likely to have a better performance status. The use of HLA-matched sibling marrow results in a lower relapse rate and, thus, for some individuals, may be preferable to the use of autologous marrow.

AB - Purpose: To analyze results of 127 patients undergoing myeloablative therapy followed by marrow transplantation for relapsed or refractory Hodgkin's disease. Patients and Methods: Twenty-three patients had primary refractory disease, 34 were in early first relapse or second complete remission (CR), and 70 had refractory first relapse or disease beyond second CR. Preparative regimens included total-body irradiation (TBI) and chemotherapy (n = 61) or chemotherapy only (n = 66). Sixty-eight patients received autologous marrow, six syngeneic marrow, and 53 allogeneic marrow. Results: The 5-year actuarial probabilities of survival, event-free survival (EFS), relapse, and nonrelapse mortality for the entire group were 21%, 18%, 65%, and 49%, respectively. HLA-identical allogeneic marrow recipients had a statistically lower relapse rate compared with recipients of autologous marrow, but survival, EFS, and nonrelapse mortality rates were not significantly different. In the multivariate analysis, higher performance status and absence of bulky disease predicted for improved EFS and lower relapse rates, while fewer prior treatment regimens predicted for improved EFS and lower nonrelapse mortality rates. Additionally, the univariate analysis showed that patients who underwent transplantation with disease refractory to chemotherapy or beyond second CR had a worse outcome compared with those who had less advanced disease. Conclusion: Outcome with transplantation for patients with Hodgkin's disease is improved if transplantation is performed early after relapse when disease burden is less, tumor chemosensitivity is greater, and the patient is likely to have a better performance status. The use of HLA-matched sibling marrow results in a lower relapse rate and, thus, for some individuals, may be preferable to the use of autologous marrow.

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