What are the risk factors that may predict post-ASCT outcomes?

FAQ published on September 11, 2017
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John Sweetenham, MD, FRCP, FACP
Professor of Medicine
Executive Medical Director
Senior Director for Clinical Affairs
Huntsman Cancer Institute
University of Utah
Salt Lake City, Utah
What are the risk factors that may predict post-ASCT outcomes?
Welcome to Managing Hodgkin Lymphoma. I am Dr. John Sweetenham. I am frequently asked, “What are the risk factors that may predict post-autologous stem cell transplant outcomes?” I think it is fair to say that although there is some consistency over these, it is important to remember that most of the studies that have looked at these factors are retrospective and relatively small. It has taken many years to really come up with some consistent risk factors that appear to be reproducible as predictors of poor outcome. Many of these factors described, and as I have said, those which have been consistently demonstrated, are as follows. First of all, patients who have primary refractory disease which fails to respond to the first-line therapy are known to be at poor risk. Similarly, those patients who relapse within 12 months of their front-line therapy appear to be another group where the risk of posttransplant relapse is higher. We also know that those patients who have B symptoms at the time of their relapse, or who had extranodal disease at the time of relapse, also carry a poorer prognosis. Recent data has emerged to show that those patients who have a positive PET scan following their initial cytoreductive therapy but prior to their transplant, appear to be at a particularly higher risk of subsequent relapse. The factors interplay, and this is one example of that. A patient who is PET negative at the time of their transplant, although overall they have a relatively favorable prognosis, if they are PET negative but had extranodal disease at the time of their relapse, their outcome is still somewhat inferior. The take-home message is that these factors interplay in each individual patient, and although they are broadly reproducible within individual patients, it is very important to assess their individual risk of relapse posttransplant specifically. Especially, since now there are interventions such as posttransplant consolidation therapy which can be applied in these groups. Thank you for viewing this activity.
Last modified: September 1, 2017
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