Multiple Factors Predict Survival In Relapsed And Primary Refractory Hl

Many groups have reported that prognostic factors other than refractory disease can predict survival. In general these factors can be divided into four categories: (1) extent of disease (advanced stage or extran-odal involvement); (2) B symptoms [or surrogate marker such as elevated erythrocyte sedimentation rate or interleukin 10 (IL-10)]; (3) remission duration of less than 1 year; (4) significant disease burden after SC. In our study of ICE SC followed by HDT and ASCT discussed above, Cox regression analysis determined that there are three factors associated with a poor outcome pre-ICE: extranodal sites of disease (ENS) (P < 0.001), initial remission duration <1 year (P = 0.001), and B symptoms (P < 0.001). Using this three-factor model, we identified three groups of patients with highly significant differences in outcome with this treatment approach. A favorable risk group having zero to one of these risk factors (56% of the patients) had FFTF of 80% measured from initiation of ICE therapy. Patients with two or three risk factors faired less well with an eventfree survival (EFS) of 40%. (Figure 75.2)

This three-factor model was the basis of our third-generation risk-adapted comprehensive study. In this, study patients with no risk factor or one risk factor (ENS, initial response duration < 1 year, or B symptoms

Outcome of patients with primary refractory disease based upon response to salvage therapy

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