Initial response to salvage therapy determines prognosis in relapsed pediatric hodgkin lymphoma patients

Monika L. Metzger, Melissa M. Hudson, Matthew J. Krasin, Jianrong Wu, Sue C. Kaste, Larry E. Kun, John T. Sandlund, Scott C. Howard

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

BACKGROUND: Pediatric Hodgkin lymphoma (HL) is a highly curable disease; however, prognostic factors for the survival of patients who develop recurrent disease have not been clearly defined. METHODS: This was a retrospective analysis of 50 pediatric patients with HL who relapsed or progressed between 1990 and 2006 and who were retrieved with intense cytoreductive treatment regimens followed by autologous stem cell transplantation and radiation therapy. A Cox proportional hazards model was used to determine risk factors for second treatment failure and death. RESULTS: The median patient age was 16.1 years (range, 4.9-22.1 years) at the time of HL diagnosis. Fifteen patients developed progressive disease during therapy, 14 patients relapsed early, and 21 patients relapsed late. Patients who remained alive at the time of this study had been followed for a median of 4.4 years (range, 1.2-16.6 years). The 5-year overall survival rate for patients who had an inadequate response (n=14) to initial salvage therapy was only 17.9% (95% confidence interval [CI], 3.1%-42.5%) compared with 97.2% (95% CI, 81.9%-99.6%) for patients who responded (n=36; P < .0001). In a multivariate Cox regression analysis of overall survival, an inadequate response to initial salvage therapy was the only significant variable (hazard ratio, 43.6; 95% CI, 5.4-354; P=.0004). CONCLUSIONS: The current results indicated that pediatric patients with relapsed HL who have an inadequate response after initial primary salvage chemotherapy have a very poor prognosis and should be considered for novel therapies directed at biologic or immunologic targets.

Original languageEnglish (US)
Pages (from-to)4376-4384
Number of pages9
JournalCancer
Volume116
Issue number18
DOIs
StatePublished - Sep 15 2010

Fingerprint

Salvage Therapy
Hodgkin Disease
Pediatrics
Confidence Intervals
Time and Motion Studies
Survival
Stem Cell Transplantation
Cell- and Tissue-Based Therapy
Treatment Failure
Proportional Hazards Models
Radiotherapy
Therapeutics
Survival Rate
Regression Analysis
Drug Therapy

Keywords

  • Hodgkin lymphoma
  • Pediatric
  • Salvage therapy
  • Treatment failure

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Metzger, M. L., Hudson, M. M., Krasin, M. J., Wu, J., Kaste, S. C., Kun, L. E., ... Howard, S. C. (2010). Initial response to salvage therapy determines prognosis in relapsed pediatric hodgkin lymphoma patients. Cancer, 116(18), 4376-4384. https://doi.org/10.1002/cncr.25225

Initial response to salvage therapy determines prognosis in relapsed pediatric hodgkin lymphoma patients. / Metzger, Monika L.; Hudson, Melissa M.; Krasin, Matthew J.; Wu, Jianrong; Kaste, Sue C.; Kun, Larry E.; Sandlund, John T.; Howard, Scott C.

In: Cancer, Vol. 116, No. 18, 15.09.2010, p. 4376-4384.

Research output: Contribution to journalArticle

Metzger, ML, Hudson, MM, Krasin, MJ, Wu, J, Kaste, SC, Kun, LE, Sandlund, JT & Howard, SC 2010, 'Initial response to salvage therapy determines prognosis in relapsed pediatric hodgkin lymphoma patients', Cancer, vol. 116, no. 18, pp. 4376-4384. https://doi.org/10.1002/cncr.25225
Metzger, Monika L. ; Hudson, Melissa M. ; Krasin, Matthew J. ; Wu, Jianrong ; Kaste, Sue C. ; Kun, Larry E. ; Sandlund, John T. ; Howard, Scott C. / Initial response to salvage therapy determines prognosis in relapsed pediatric hodgkin lymphoma patients. In: Cancer. 2010 ; Vol. 116, No. 18. pp. 4376-4384.
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abstract = "BACKGROUND: Pediatric Hodgkin lymphoma (HL) is a highly curable disease; however, prognostic factors for the survival of patients who develop recurrent disease have not been clearly defined. METHODS: This was a retrospective analysis of 50 pediatric patients with HL who relapsed or progressed between 1990 and 2006 and who were retrieved with intense cytoreductive treatment regimens followed by autologous stem cell transplantation and radiation therapy. A Cox proportional hazards model was used to determine risk factors for second treatment failure and death. RESULTS: The median patient age was 16.1 years (range, 4.9-22.1 years) at the time of HL diagnosis. Fifteen patients developed progressive disease during therapy, 14 patients relapsed early, and 21 patients relapsed late. Patients who remained alive at the time of this study had been followed for a median of 4.4 years (range, 1.2-16.6 years). The 5-year overall survival rate for patients who had an inadequate response (n=14) to initial salvage therapy was only 17.9{\%} (95{\%} confidence interval [CI], 3.1{\%}-42.5{\%}) compared with 97.2{\%} (95{\%} CI, 81.9{\%}-99.6{\%}) for patients who responded (n=36; P < .0001). In a multivariate Cox regression analysis of overall survival, an inadequate response to initial salvage therapy was the only significant variable (hazard ratio, 43.6; 95{\%} CI, 5.4-354; P=.0004). CONCLUSIONS: The current results indicated that pediatric patients with relapsed HL who have an inadequate response after initial primary salvage chemotherapy have a very poor prognosis and should be considered for novel therapies directed at biologic or immunologic targets.",
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N2 - BACKGROUND: Pediatric Hodgkin lymphoma (HL) is a highly curable disease; however, prognostic factors for the survival of patients who develop recurrent disease have not been clearly defined. METHODS: This was a retrospective analysis of 50 pediatric patients with HL who relapsed or progressed between 1990 and 2006 and who were retrieved with intense cytoreductive treatment regimens followed by autologous stem cell transplantation and radiation therapy. A Cox proportional hazards model was used to determine risk factors for second treatment failure and death. RESULTS: The median patient age was 16.1 years (range, 4.9-22.1 years) at the time of HL diagnosis. Fifteen patients developed progressive disease during therapy, 14 patients relapsed early, and 21 patients relapsed late. Patients who remained alive at the time of this study had been followed for a median of 4.4 years (range, 1.2-16.6 years). The 5-year overall survival rate for patients who had an inadequate response (n=14) to initial salvage therapy was only 17.9% (95% confidence interval [CI], 3.1%-42.5%) compared with 97.2% (95% CI, 81.9%-99.6%) for patients who responded (n=36; P < .0001). In a multivariate Cox regression analysis of overall survival, an inadequate response to initial salvage therapy was the only significant variable (hazard ratio, 43.6; 95% CI, 5.4-354; P=.0004). CONCLUSIONS: The current results indicated that pediatric patients with relapsed HL who have an inadequate response after initial primary salvage chemotherapy have a very poor prognosis and should be considered for novel therapies directed at biologic or immunologic targets.

AB - BACKGROUND: Pediatric Hodgkin lymphoma (HL) is a highly curable disease; however, prognostic factors for the survival of patients who develop recurrent disease have not been clearly defined. METHODS: This was a retrospective analysis of 50 pediatric patients with HL who relapsed or progressed between 1990 and 2006 and who were retrieved with intense cytoreductive treatment regimens followed by autologous stem cell transplantation and radiation therapy. A Cox proportional hazards model was used to determine risk factors for second treatment failure and death. RESULTS: The median patient age was 16.1 years (range, 4.9-22.1 years) at the time of HL diagnosis. Fifteen patients developed progressive disease during therapy, 14 patients relapsed early, and 21 patients relapsed late. Patients who remained alive at the time of this study had been followed for a median of 4.4 years (range, 1.2-16.6 years). The 5-year overall survival rate for patients who had an inadequate response (n=14) to initial salvage therapy was only 17.9% (95% confidence interval [CI], 3.1%-42.5%) compared with 97.2% (95% CI, 81.9%-99.6%) for patients who responded (n=36; P < .0001). In a multivariate Cox regression analysis of overall survival, an inadequate response to initial salvage therapy was the only significant variable (hazard ratio, 43.6; 95% CI, 5.4-354; P=.0004). CONCLUSIONS: The current results indicated that pediatric patients with relapsed HL who have an inadequate response after initial primary salvage chemotherapy have a very poor prognosis and should be considered for novel therapies directed at biologic or immunologic targets.

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