In this multi-center study of 1,617 patients who survived for at least two years following autologous hematopoietic cell transplantation (auto-HCT) for Hodgkin lymphoma (HL) or diffuse large B-cell lymphoma (DLBCL), 5-year disease-free survival (DFS) was >80%.
All patients were transplanted between 1990 and 2008, with outcomes reported to the CIBMTR® (Center for International Blood and Marrow Transplant Research®). Median age was 33 years (range, 15-77) in patients with HL and 51 years (range, 15-77) in patients with DLBCL. Median follow-up was 10.6 years (range, 24-292 months) after auto-HCT.
Overall survival (OS) and DFS at 5 years were 90% and 84%, respectively, for patients with HL, and 89% and 82%, respectively, for patients with DLBCL.
A multivariate analysis revealed the following risk factors for overall mortality in patients with HL: older age (p<0.001), male sex (p=0.039), Karnofsky score <90 (p=0.011), total body irradiation (TBI) (p<0.001), and higher numbers of lines of chemotherapy prior to auto-HCT (p<0.001).
For DLBCL, risk factors by multivariate analysis included older age (p<0.001) and TBI (p=0.013) for overall mortality, older age (p<0.001) and TBI (p=0.043) for non-relapse mortality, and older age (p<0.001) for new malignancies.
Leading causes of death included relapse (44%), new malignancy (10%), organ failure (7%), and infection (4%). At least one non-malignant late effect was reported in 7% of survivors, and 105 new malignancies were confirmed, 44 in HL and 61 in DLBCL survivors.
In combined multivariate models of the entire study cohort, the diagnosis of HL was a risk factor for both overall mortality (p<0.001) and non-relapse mortality (p<0.001). The standardized mortality ratio was 9.6 (95% CI 8.1-11.2) for HL and 3.4 (95% CI 2.9-4.1) for DLBCL compared to the general population. Sub-analysis results for 798 adolescent and young adult (AYA) patients reflected the overall study population.