Document Type : Original Article(s)
Authors
- Navid Mohseni 1
- Ali Akbar Khadem Maboudi 1
- Ahmadreza Baghestani 1
- Abbas Hajifathali 2
- Anahita Saeedi 1
1 Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Background: Hodgkin lymphoma (HL) is one of the best curable malignancies. Randomized controlled studies have validated the benefit of hematopoietic stem cell transplant (HSCT) for patients with relapsed or primary refractory HL. This analysis aimed to identify significant prognostic factors on the recurrence of the disease after HSCT applying a cure rate model.
Method: In this retrospective cohort study, there were 92 patients with HL who underwent HSCT from 2007 to 2014 with 18 months of follow-up in Tehran, Iran. The survival time was set as the time interval between transplantation and the recurrence of HL. In addition, we utilized hyper-Poisson distribution as discrete frailty to account the unobserved heterogeneity and random effects.
Results: In non-cured cases, the mean of survival time was 318 (95% confidence interval, 144-493) days. The 1-, 3-, and 5-year survival rates were 88.9%, 83.4%, and 80.7%, respectively. A significant association was observed between the cured patients and the variables such as age, the experience of pre-transplantation relapse, hemoglobin (Hb), mononuclear cells (MNCs), and body surface area (BSA) at the time of transplantation.
Conclusion: The study concluded that less than 30 years of age, a high level of Hb (g/dl), a low level of MNCs and BSA (m2), and the absence of pre-transplantation experience of relapse were associated with better survival following HSCT. Based on this study, post-transplant consolidation therapies could be considered for the treatment of HL patients after HSCT.
Keywords
How to cite this article:
Mohseni N, Khadem Maboudi AA, Baghestani A, Hajifathali A, Saeedi A. A cure rate survival model after stem cell transplantation for relapsed or refractory Hodgkin lymphoma patients. Middle East J Cancer. 2022;13(3):427-37. doi: 10.30476/ mejc.2021.88135.1461.
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA , Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492.
- Zhou L, Deng Y, Li N, Zheng Y, Tian T, Zhai Z, et al. Global, regional, and national burden of Hodgkin lymphoma from 1990 to 2017: estimates from the 2017 Global Burden of Disease study. J Hematol Oncol. 2019;12(1):107. doi: 10.1186/s13045-019-0799-1.
- World Health Organization., IARC monographs on the evaluation of carcinogenic risks to humans: Some Traditional Herbal Medicines, Some Mycotoxins, Naphthaleneand Styrene. Lyon; 2002, Vol 82. 978-92-832-1582-0.
- Engert A, Plütschow A, Eich HT, Lohri A, Dörken B, Borchmann P, et al. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med. 2010;363(7):640-52. doi: 10.1056/NEJMoa1000067.
- GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-88. doi: 10.1016/S0140-6736(18)32203-7. Erratum in: Lancet. 2019;393(10190):e44. Erratum in: Lancet. 2018;392(10160):2170.
- von Tresckow B , Moskowitz CH. Treatment of relapsed and refractory Hodgkin lymphoma. Semin Hematol. 2016;53(3):180-185. doi:10.1053/j.seminhematol.2016.05.010.
- Linch DC, Winfield D, Goldstone AH, Moir D, Hancock B, McMillan A, et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet. 1993;341(8852):1051-4. doi: 10.1016/0140-6736(93)92411-l.
- Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. Lancet. 2002;359(9323):2065-71. doi: 10.1016/S0140-6736(02)08938-9.
- Josting A, Reiser M, Rueffer U, Salzberger B, Diehl V , Engert A. Treatment of primary progressive Hodgkin's and aggressive non-Hodgkin's lymphoma: is there a chance for cure? J Clin Oncol. 2000;18(2):332-9. doi:10.1200/jco.2000.18.2.332.
- Reece DE, Connors JM, Spinelli JJ, Barnett MJ, Fairey RN, Klingemann HG, 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):1193-9.
- Sayadi L, Jafaraghaee F, Jeddian A, Atrian MK, Akbari A , Tootoonchian F. Views of patients undergo hematopoietic stem cell transplantation on their basic needs. Int J Hematol Oncol Stem Cell Res. 2013;7(2):23-9.
- Gratwohl A, Baldomero H, Aljurf M, Pasquini MC, Bouzas LF, Yoshimi A, et al. Hematopoietic stem cell transplantation: a global perspective. JAMA. 2010;303(16):1617-24. doi: 10.1001/jama.2010.491.
- Ghavamzadeh A, Alimoghaddam K, Ghaffari F, Derakhshandeh R, Jalali A , Jahani M. Twenty years of experience on stem cell transplantation in iran. Iran Red Crescent Med J. 2013;15(2):93-100. doi:10.5812/ircmj.1915.
- Josting A, Franklin J, May M, Koch P, Beykirch MK, Heinz J, 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):221-30. doi: 10.1200/JCO.2002.20.1.221.
- Sureda A, Constans M, Iriondo A, Arranz R, Caballero MD, Vidal MJ, et al. Prognostic factors affecting long-term outcome after stem cell transplantation in Hodgkin's lymphoma autografted after a first relapse. Ann Oncol. 2005;16(4):625-33. doi: 10.1093/annonc/mdi119.
- Satwani P, Ahn KW, Carreras J, Abdel-Azim H, Cairo MS, Cashen A, et al. A prognostic model predicting autologous transplantation outcomes in children, adolescents and young adults with Hodgkin lymphoma. Bone Marrow Transplant. 2015;50(11):1416-23. doi: 10.1038/bmt.2015.177.
- Perdoná GC , Louzada-Neto F. A general hazard model for lifetime data in the presence of cure rate. J Appl Stat. 2011;38(7):1395-405. doi:10.1080/02664763.2010.505948.
- Barriga GD, Cancho VG, Garibay DV, Cordeiro GM , Ortega EM. A new survival model with surviving fraction: An application to colorectal cancer data. Stat Methods Med Res. 2019;28(9):2665-80. doi:10.1177/0962280218786053.
- de Souza D, Cancho VG, Rodrigues J , Balakrishnan N. Bayesian cure rate models induced by frailty in survival analysis. Stat Methods Med Res. 2017;26(5):2011-28. doi:10.1177/0962280217708671.
- Brice P, Bouabdallah R, Moreau P, Divine M, André M, Aoudjane M, et al. Prognostic factors for survival after high-dose therapy and autologous stem cell transplantation for patients with relapsing Hodgkin's disease: analysis of 280 patients from the French registry. Bone Marrow Transplant. 1997;20(1):21-6. doi: 10.1038/sj.bmt.1700838.
- Devetten MP, Hari PN, Carreras J, Logan BR, van Besien K, Bredeson CN, et al. Unrelated donor reduced-intensity allogeneic hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma. Biol Blood Marrow Transplant. 2009;15(1):109-17. doi: 10.1016/j.bbmt.2008.11.011.
- Townsend W, Leong S, Hoskin P, Diez P, Patrick P, Linch D, et al. Treatment of classical Hodgkin lymphoma in young adults aged 18-30 years with a modified paediatric Hodgkin lymphoma protocol. Results of a multicentre phase II clinical trial (CRUK/08/012). Br J Haematol. 2020;189(1):128-32. doi: 10.1111/bjh.16296.
- Cancho VG, Barriga G, Leão J , Saulo H. Survival model induced by discrete frailty for modeling of lifetime data with long-term survivors and change-point. Commun Stat Theory Methods. 2019:1-12. doi:10.1080/03610926.2019.1648826.
- Bardwell GE , Crow EL. A Two-parameter family of hyper-poisson distributions. J Am Stat Assoc. 1964;59(305):133-41. doi:10.1080/01621459.1964.10480706.
- Josting A, Rudolph C, Mapara M, Glossmann JP, Sieniawski M, Sieber M, et al. Cologne high-dose sequential chemotherapy in relapsed and refractory Hodgkin lymphoma: results of a large multicenter study of the German Hodgkin Lymphoma Study Group (GHSG). Ann Oncol. 2005;16(1):116-23. doi: 10.1093/annonc/mdi003. Erratum in: Ann Oncol. 2008;19(8):1515. Sienawski, M [corrected to Sieniawski, M]. Erratum in: Ann Oncol. 2008;19(8):1515.
- Kwan A, Chadwick N , Hancock B. Improving survival of patients with Hodgkin lymphoma over 4 decades: Experience of the British National Lymphoma Investigation (BNLI) With 6834 patients. Clin Lymphoma Myeloma Leuk. 2017;17(2):108-19. doi:10.1016/j.clml.2016.11.004.
- Shanbhag S , Ambinder RF. Hodgkin lymphoma: A review and update on recent progress. CA Cancer J Clin. 2018;68(2):116-32. doi:10.3322/caac.21438.
- Bierman PJ, Bagin RG, Jagannath S, Vose JM, Spitzer G, Kessinger A, et al. High dose chemotherapy followed by autologous hematopoietic rescue in Hodgkin's disease: long-term follow-up in 128 patients. Ann Oncol. 1993;4(9):767-73. doi: 10.1093/oxfordjournals.annonc.a058662.
- Horning SJ, Chao NJ, Negrin RS, Hoppe RT, Long GD, Hu WW, et al. High-dose therapy and autologous hematopoietic progenitor cell transplantation for recurrent or refractory Hodgkin's disease: analysis of the Stanford University results and prognostic indices. Blood. 1997;89(3):801-13.
- Talleur AC, Flerlage JE, Shook DR, Chilsen AM, Hudson MM, Cheng C, et al. Autologous hematopoietic cell transplantation for the treatment of relapsed/refractory pediatric, adolescent, and young adult Hodgkin lymphoma: a single institutional experience. Bone Marrow Transplant. 2020;55(7):1357-66. doi: 10.1038/s41409-020-0879-4.
- Williams CD, Goldstone AH, Pearce R, Green S, Armitage JO, Carella A, et al. Autologous bone marrow transplantation for pediatric Hodgkin's disease: a case-matched comparison with adult patients by the European Bone Marrow Transplant Group Lymphoma Registry. J Clin Oncol. 1993;11(11):2243-9. doi: 10.1200/JCO.1993.11.11.2243.
- Majhail NS, Weisdorf DJ, Defor TE, Miller JS, McGlave PB, Slungaard A, 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):1065-72. doi: 10.1016/j.bbmt.2006.06.006.
- Anderson JE, Litzow MR, Appelbaum FR, Schoch G, Fisher LD, Buckner CD, et al. Allogeneic, syngeneic, and autologous marrow transplantation for Hodgkin's disease: the 21-year Seattle experience. J Clin Oncol. 1993;11(12):2342-50. doi: 10.1200/JCO.1993.11.12.2342.
- Jones RJ, Piantadosi S, Mann RB, Ambinder RF, Seifter EJ, Vriesendorp HM, et al. High-dose cytotoxic therapy and bone marrow transplantation for relapsed Hodgkin's disease. J Clin Oncol. 1990;8(3):527-37. doi: 10.1200/JCO.1990.8.3.527.
- Milpied N, Fielding AK, Pearce RM, Ernst P , Goldstone AH. Allogeneic bone marrow transplant is not better than autologous transplant for patients with relapsed Hodgkin's disease. European Group for Blood and Bone Marrow Transplantation. J Clin Oncol. 1996;14(4):1291-6. doi:10.1200/jco.1996.14.4.1291.
- Argiris A, Seropian S , Cooper DL. High-dose BEAM chemotherapy with autologous peripheral blood progenitor-cell transplantation for unselected patients with primary refractory or relapsed Hodgkin's disease. Ann Oncol. 2000;11(6):665-72. doi:10.1023/a:1008396525292.
- Fermé C, Mounier N, Diviné M, Brice P, Stamatoullas A, Reman O, 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'Etudes des Lymphomes de l'Adulte H89 Trial. J Clin Oncol. 2002;20(2):467-75. doi: 10.1200/JCO.2002.20.2.467.
- Hasenclever D , Diehl V. A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med. 1998;339(21):1506-14. doi:10.1056/nejm199811193392104.
- Moghaddam Tabrizi F , Barjasteh S. Maternal hemoglobin levels during pregnancy and their association with birth weight of neonates. Iran J Ped Hematol Oncol. 2015;5(4):211-7.
- Shamloo N, Ghannadan A, Jafari M, Ahmadi S, Mortazavi H , Baharvand M. Head and neck lymphoma in an Iranian population. Iran J Otorhinolaryngol. 2017;29(94):261-7. doi:10.22038/IJORL.2017.21392.1715.
- Newcom SR, Kadin ME , Phillips C. L-428 Reed-Sternberg cells and mononuclear Hodgkin's cells arise from a single cloned mononuclear cell. Int J Cell Cloning. 1988;6(6):417-31. doi:10.1002/stem.5530060606.
- Bröckelmann PJ, Müller H, Casasnovas O, Hutchings M, von Tresckow B, Jürgens M, et al. Risk factors and a prognostic score for survival after autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma. Ann Oncol. 2017;28(6):1352-8. doi: 10.1093/annonc/mdx072.
- Strongman H, Brown A, Smeeth L , Bhaskaran K. Body mass index and Hodgkin's lymphoma: UK population-based cohort study of 5.8 million individuals. Br J Cancer. 2019;120(7):768-70. doi:10.1038/s41416-019-0401-1.
- Le Blanc K, Ringdén O, Remberger M. A low body mass index is correlated with poor survival after allogeneic stem cell transplantation. Haematologica. 2003;88(9):1044-52.