Retrospective evaluation of the results of autological hematopoetic stem cell transplantation after relaps/refractory hodgkin disease

Approximately 50% of patients with relapsed/refractory Hodgkin Lymphoma (HL) may die due to recurrence, progression, or complications. After salvage treatment, Autologous Hematopoietic Stem Cell Transplantation (AHSCT) is a standard approach. Transplantation can be applied to provide disease control, improve quality of life, or alleviate symptoms. In our study, we aimed to determine the prognostic risk factors that affect the survival time after AHSCT. A total of 35 patients who are older than 18 years of age, diagnosis of relapsed/refractory HL and underwent AHSCT were included. The information of the patients was obtained from the hospital system. Kaplan-Meier survey analysis was used to estimate progression-free (PFS) and overall survival (OS). Cox regression model was used to evaluate potential prognostic variables. There are 35 patients diagnosed with relapsed/refractory HL who underwent AHSCT between January 2009 and March 2020 in our hospital. 54% of patients are male. The median age of diagnosis is 29 (14-62) and the age of transplant is 33 (22-62). After primary chemotherapy, 34% of the patients were refractory and 66% were in remission. Rescue treatment resulted in 26% complete response, 6% partial response, and 68% refractory. After AHSCT, 77% of patients were alive and 23% were died. That patients who died, 88% died due to lymphoma, and 12% died due to a cause other than lymphoma. After AHSCT, 49% patients developed remission and 51% patients relapsed who were 39% remission, 17% refractory and 44% died after treatment. The overall survival time was 89% at 3 months, 86% at 1 year, 75% at 3 years and 75% at 5 years; disease-free survival time was 77% at 3 months, 67% at 1 year, 32% at 3 years, and 21% at 5 years. According to AHSCT's results, mean OS is 100 (±8.9) months and PFS is 60 (±10.7) months. The median survival of those who died after AHSCT was 12 (±4.5) months; survival of those who relapsed was 33 (±5.7) months. In our study, it was observed that the duration of relapse was less than 12 months (p=0.033) and the sedimentation level at the time of recurrence was normal (p=0.021) had a significant effect on PFS. Normal LDH level at the time of recurrence (p=0.022) had a significant effect on OS. No prognostic risk factor effective on OS was detected in multivariate analysis. In addition, it was found that an increase in hemoglobin level on PFS increased the risk of relapse 1.67 times. It was determined that a one-unit increase in neutrophil engraftment on PFS reduced the risk of relapse by 30%. However, in our study, it was observed that non-significant risk factors significantly extended survival times. PFS durations are extended approximately 1 to 5 years and OS durations are extended between 4 months and 5 years by early stage, age at diagnosis below 40, female gender, histological diagnosis nodular sclerosing Hogkin lymphoma (NSCHL), no B symptoms, normal diagnosis of LDH, sedimentation and beta-2 microglobulin, no bulky mass, radiotherapy before transplantation, responding to primary chemotherapy, having normal beta-2 microglobulin at the time of relapse, and increasing the number of rescue regimens. Patients who underwent AHSCT because of high risk of relapsed/refractory HL seem to have a high mortality. However, there are not enough studies to reduce mortality. Today, studies are carried out to investigate prognostic factors in order to improve survival after AHSCT. In the study, the risk factors affecting the OS and PFS results of the patients who underwent AHSCT with a diagnosis of relapsed/refractory HL in our center were evaluated. In addition, our study was compared with the results of other studies in order to detect differences and similarities. Keyword: Autologous Hematopoietic Stem Cell Transplantation, Hodgkin Lymphoma, Overall Survival (OS), Progression-Free Survival (PFS)