Although half are cured by transplant,1,2 relapse may be closer than you think for some
There will be an estimated 9,190 new cases of Hodgkin
lymphoma (HL) in the US in 2014.3 HL is considered a
highly curable disease; however, up to 10% of patients
are refractory to frontline therapy, and up to 30% of
patients will eventually relapse.4,5 The standard approach
for relapsed HL is autologous stem cell transplantation
(ASCT), which has a 5-year progression-free survival rate
of approximately 50%.1,2,6
Among those who relapse after ASCT, prognosis
has traditionally been poor, with a median survival
of 1.3 years following relapse.6,7 Further, the majority
of relapses occur within 1 year.7 As advances continue
in the treatment of HL, utilization of clinical prognostic
factors may help identify a group of patients who are
at high risk of relapse.1,2,6,8-16
Progression-free survival based on a
prognostic model using risk groups1,*
Risk factors that may help identify patients
who will relapse following ASCT
1.0
• Refractory disease or early relapse after frontline therapy 2,8-11
• Extranodal disease at pre-ASCT relapse 2,8,10-12
0.8
• Lack of chemoresponsiveness pre-ASCT 1,2,13
• Residual disease at time of ASCT 1
• Positive FDG-PET scan pre-ASCT 14-16
• Bulky disease pre-ASCT 2,12
• Higher disease stage at relapse 8,9
• Anemia pre-ASCT
Cumulative proportion
• B symptoms at pre-ASCT relapse1,8-11,13
Low-risk group
0.6
Intermediate-risk group
0.4
0.2
High-risk group
8,9
• >1 relapse or >2 prior regimens1,9
0.0
0
12
24
36
48
60
72
Months
Months
*High, intermediate and low risk were defined as patients with 0-1, 2 or 3 risk factors,
respectively. The 3 factors incorporated into the model were B symptoms at pre-ASCT
relapse, transplantation in CR and chemosensitive disease at the time of ASCT.1
HLbelowthesurface.com
References: 1. Majhail NS, Weisdorf DJ, Defor TE, et al. Long-term results of autologous stem cell transplantation for primary refractory or relapsed Hodgkin’s lymphoma. Biol Blood Marrow
Transplant. 2006;12(10):1065-1072. 2. Sureda A, Constans M, Iriondo A, et al; for Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea (GEL/TAMO) Cooperative Group. Prognostic
factors affecting long-term outcome after stem cell transplantation in Hodgkin’s lymphoma autografted after a first relapse. Ann Oncol. 2005;16(4):625-633. 3. American Cancer Society. Cancer
Facts & Figures 2014. Atlanta, GA: American Cancer Society; 2014. 4. Derenzini E, Younes A. Predicting treatment outcome in classical Hodgkin lymphoma: genomic advances. Genome Med.
2011;3(4):26. doi:10.1186/gm240. 5. Quddus F, Armitage JO. Salvage therapy for Hodgkin’s lymphoma. Cancer J. 2009;15(2):161-163. 6. Colpo A, Hochberg E, Chen Y-B. Current status of
autologous stem cell transplantation in relapsed and refractory Hodgkin’s lymphoma. Oncologist. 2012;17(1):80-90. 7. Arai S, Fanale M, deVos S, et al. Defining a Hodgkin lymphoma population
for novel therapeutics after relapse from autologous hematopoietic cell transplant. Leuk Lymphoma. 2013;54(11):2531-2533. 8. Josting A, Franklin J, May M, et al. New prognostic score based
on treatment outcome of patients with relapsed Hodgkin’s lymphoma registered in the database of the German Hodgkin’s Lymphoma Study Group. J Clin Oncol. 2002;20(1):221-230. 9. Josting A,
Müller H, Borchmann P, et al. Dose intensity of chemotherapy in patients with relapsed Hodgkin’s lymphoma. J Clin Oncol. 2010;28(34):5074-5080. 10. Reece DE, Connors JM, Spinelli JJ, et al.
Intensive therapy with cyclophosphamide, carmustine, etoposide ± cisplatin, and autologous bone marrow transplantation for Hodgkin’s disease in first relapse after combination chemotherapy.
Blood. 1994;83(5):1193-1199. 11. Moskowitz CH, Nimer SD, Zelenetz AD, et al. A 2-step comprehensive high-dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin
disease: analysis by intent to treat and development of a prognostic model. Blood. 2001;97(3):616-623. 12. Smith SD, Moskowitz CH, Dean R, et al. Autologous stem cell transplant for early
relapsed/refractory Hodgkin lymphoma: results from two transplant centres. Br J Haematol. 2011;153(3):358-363. 13. Fermé C, Mounier N, Diviné M, et al. Intensive salvage therapy with
high-dose chemotherapy for patients with advanced Hodgkin’s disease in relapse or failure after initial chemotherapy: results of the Groupe d’Études des Lymphomes de l’Adulte H89 trial. J Clin Oncol.
2002;20(2):467-475. 14. Moskowitz AJ, Yahalo