复发难治性NK/T细胞淋巴瘤疗效及预后相关因素

目的 分析复发难治性NK/T细胞淋巴瘤患者的有效治疗方法和预后相关因素.方法 回顾性分析1999年1月至2007年6月中山大学肿瘤医院收治的复发及难治的NK/T细胞淋巴瘤24例,并进行单因素和多因素分析.结果 截至末次随访时间2007年6月,中位随访期7(1.5～38)个月,共生存5例,复发后中位生存期(MST)7(1.5～38)个月,预计1、2、3年总生存(OS)率分别为33.3%、4.2%、4.2%.多因素分析结果提示,复发后骨髓受累、复发后PS与全身性复发NK/T细胞淋巴瘤患者复发后OS率密切相关,是独立预后指标.2例接受自体外周血干细胞移植(AHSCT)患者无瘤生存期分别是19、38个月.结论复发后骨髓受累情况、PS是复发难治性NK/T细胞淋巴瘤独立预后因素,复发难治性NK/T细胞淋巴瘤患者预后较差,MST短,化疗敏感患者采用AHSCT,可能提高其生存.     

韦氏环非霍奇金淋巴瘤综合治疗疗效及其预后因素分析

目的:探讨韦氏环非霍奇金淋巴瘤(NHL)综合治疗疗效及影响预后的因素.方法:回顾分析2001-07-2010-07收治的63例韦氏环NHL所有病例,用Kaplan-Meier计算其3、5年总生存率(OS)和无瘤生存率(DFS),Log-rank进行显著性检验,Cox模型进行单因素和多因素分析.结果:全组死亡20倒,3、5年OS分别为76.1％和64.4％.3、5年DFS分别为69.0％和61.6％.原发灶放射治疗剂量＜40、40～50 及＞50 Gy的5年OS分别为48.6％,73.7％和48.2％,x2=3.766,P=0.152.放疗前给予≥3个周期的化疗组及＜3个周期的化疗组5年OS分别为71.3％和58.5％·x2=0.797,P=0.372.多因素分析结果显示,近期疗效与国际预后指数(IPI)是独立预后因素.结论:对于韦氏环NHL患者宜采取综合治疗模式.近期疗效与IPI可作为韦氏环NHL临床预后的参考指标.     

Hyper-CVAD方案治疗侵袭性T细胞淋巴瘤的效果和安全性

目的 评价Hyper-CVAD化疗方案治疗侵袭性T细胞淋巴瘤的效果和安全性.方法 对2009年9月至2010年12月在北京协和医院接受Hyper-CVAD方案诱导化疗的34例初诊侵袭性T细胞淋巴瘤患者的疗效和不良反应等资料进行回顾性分析,并进行生存分析.结果 34例患者接受Hyper-CVAD方案诱导化疗后,28例(82.4％)有治疗反应,其中10例(29.4％)获得完全缓解(CR);11例接受造血干细胞移植(包括1例同胞全合异基因造血干细胞移植).中位随访时间16个月(1～82个月),1、3年总生存(OS)率分别为70.2％、41.1％;1、3年无进展生存(PFS)率分别为49.3％、31.6％.化疗不良反应主要为骨髓抑制,18例(52.9％)发生Ⅳ级骨髓抑制;3例因严重感染死亡.Cox多因素分析显示,化疗能否达到CR是PFS的独立影响因素(HR=6.118,95％CI 1.327～28.206,P=0.020);骨髓是否受累(HR=0.270,95％CI 0.101～0.722,P=0.009)和化疗能否达到CR(HR=6.669,95％CI 1.754～25.354,P=0.005)是OS的独立影响因素.结论 Hyper-CVAD方案诱导化疗治疗侵袭性T细胞淋巴瘤的反应率高,但有效持续时间短,远期疗效不佳,同时骨髓抑制严重,感染发生率高.缓解后行自体造血干细胞移植可能提高侵袭性T细胞淋巴瘤的疗效.     

70例结内弥漫大B细胞淋巴瘤的临床特征、免疫亚型与预后分析

背景与目的:弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)根据基因表达可以分成有两种不同预后的亚型:生发中心B细胞样亚型(germinal centre B-cell lymphoma,GCB)和活化B细胞样亚型(non-germinal centre B-cell lymphoma,non-GCB).本文分析原发于淋巴结内DLBCL的临床特征、免疫亚型及预后,并探讨有效的治疗方法.方法:收集本院2003年-2009年诊治的70例结内DLBCL.分析其临床资料和IPI评分,用免疫组织化学染色分成GCB和non-GCB两类免疫亚型.治疗方法包括CHOP化疗及利妥昔单抗联合CHOP (R-CHOP)免疫化疗.用Kaplan-Meier法、log-rank检验和Cox回归模型对其临床资料、免疫亚型和治疗结果进行生存分析及单因素和多因素预后分析.结果:全组患者的5年生存期(overall survival,OS)为67.8％.其中CHOP化疗患者的5年OS为58.9％,R-CHOP免疫化疗患者为77.2％,免疫化疗明显优于单纯化疗(P=O.017).免疫亚型为GCB型患者5年OS为73％,non-GCB型患者为55.9％,两者差异无统计学意义(P=0.13).但进一步分析:用CHOP化疗的non-GCB型患者5年OS明显低于GCB型患者(43.5％ vs 66.8％,P=0.042);而用R-CHOP免疫化疗的non-GCB型患者5年OS与GCB型患者差异无统计学意义(67.5％ vs 80.4％,P=0.717).在nonGCB亚型中,R-CHOP免疫化疗5年OS明显优于CHOP化疗(73.3％ vs 42.9％,P=0.02),提示R-CHOP免疫化疗能明显延长non-GCB亚型患者的长期生存.各临床因素与OS的关系:单因素分析表明年龄≥60岁、Ⅲ期、血清LDH升高、B症状和IPI≥3分均是预后不良的因素(P＜0.05).Cox多因素回归模型分析结果显示,IPI评分对OS的影响有统计学意义(P＜0.01),是独立的预后因素.结论:IPI可以预测结内DLBCL的预后和生存.采用免疫组化对DLBCL免疫分型对指导治疗有一定意义.R-CHOP免疫化疗能够显著提高结内DLBCL患者的长期生存率.     

84例鼻型NK/T细胞淋巴瘤的治疗与预后分析

目的 分析鼻型NK/T细胞淋巴瘤的临床特征、不同治疗方法的疗效及影响预后的因素.方法 回顾性分析经病理证实的84例鼻型NK/T细胞NHL患者的临床资料,其中48例经免疫组化证实.根据Ann Arbor分期,Ⅰ期46例,Ⅱ期19例,Ⅲ期16例,Ⅳ期3例.单纯放疗29例,单纯化疗5例,放疗、化疗结合50例.预后判断采用Cox多因素回归模型分析.结果 全组5年总生存（OS）和无病生存（DFS）率分别为48.8%与35.7%.首程治疗后达CR的5年OS为59.4%,未达CR的5年OS为15.0%（P＜0.01）.单纯化疗中1例达CR（20.0%）,单纯放疗21例达CR（72.4%）,放疗、化疗结合42例达CR（84.0%）,放疗、化疗结合与单纯放疗后达CR明显高于单纯化疗（P＜0.01）.单纯放疗和放疗、化疗结合的5年OS率分别为44.8%和54.0%（P＞0.05）,均明显高于单纯化疗20.0%（P＜0.05）;单纯放疗和放疗、化疗结合的5年DFS分别为34.5%、40.0%,明显高于单纯化疗（P＜0.01）.多因素回归分析显示：IPI、首程CR、B症状、鼻中隔和（或）硬腭穿孔及治疗方法为影响生存的独立预后因素,其中以IPI评分最明显.结论 对鼻型NK/T淋巴瘤采用单纯化疗疗效差,而放疗、化疗结合疗效较好,但远期生存情况仍不满意.     

异基因造血干细胞移植治疗外周T细胞淋巴瘤现状

外周T细胞淋巴瘤作为一组异质性肿瘤,大多侵袭性强,易出现复发和耐药,预后极差.以化疗和自体造血干细胞移植(ASCT)为基础的治疗,5年无病生存率不足30％.异基因造血干细胞移植(allo-HSCT)治疗外周T细胞淋巴瘤具有移植物抗淋巴瘤效应,治疗复发难治性外周T细胞淋巴瘤的长期无病生存率达35％～50％.allo-HSCT可作为治疗外周T细胞淋巴瘤的有效手段.     

局部区域复发早期结外鼻型NK/T细胞淋巴瘤挽救治疗初步预后分析

目的 回顾分析局部区域复发的早期结外鼻型NK/T细胞淋巴瘤挽救治疗预后因素。方法 按入组标准纳入1995-2014年间首次治疗后出现局部区域复发且接受了挽救治疗的早期结外鼻型NK/T细胞淋巴瘤56例,分析挽救治疗对OS、复发后OS的影响,并对复发后OS进行单因素及多因素预后分析。结果 总中位随访时间 35.9个月,3年OS率为73%。复发后中位随访时间14.8个月,3年复发后OS率为58%。挽救治疗方式中加入放疗较单纯化疗提高了OS (P=0.040)和复发后OS (P=0.009),二程放疗较单纯化疗提高了OS (P=0.018)和复发后OS (P=0.019),二程放疗的急性及晚期不良反应多为1-2级(84%)。在单因素和多因素分析中KPS评分、首治有无放疗、挽救有无放疗均对复发后OS有影响。结论 放疗是局部区域复发的结外鼻型NK/T细胞淋巴瘤挽救治疗中不可或缺手段,能改善生存且不良反应可接受。     

自体造血干细胞移植治疗复发难治非霍奇金淋巴瘤

目的探讨高剂量放化疗联合自体造血干细胞移植治疗复发、耐药侵袭性和高度侵袭性非霍奇金淋巴瘤(NHL)的疗效和安全性。方法23例复发和11例耐药的NHL患者接受了解救化疗和自体造血干细胞采集,采集后进行了自体造血干细胞支持下的高剂量放化疗。结果采集到的全部患者干细胞数均达到了移植要求,CD34+细胞中位数为6.06×106/kg。接受移植的患者经高剂量放化疗治疗后全部出现Ⅳ度骨髓抑制,出现1例移植相关死亡。移植后23例完全缓解,6例部分缓解,5例进展。缓解的患者中,10例复发,中位疾病进展时间(TTP)为7.9个月,复发患者中7例死亡。1例发生第二肿瘤。5年总生存率为60.5%,5年无复发总生存率为58.2%。结论高剂量放化疗联合自体造血干细胞移植治疗复发耐药的侵袭和高度侵袭性NHL疗效高、安全性好,但对于预后差的患者尚需探讨新的方法。     

T细胞非霍奇金淋巴瘤Ki-67表达及其临床意义

目的:探讨T细胞非霍奇金淋巴瘤(NHL)Ki-67表达及其临床意义.方法:回顾性分析天津医科大学附属肿瘤医院2000年1月～2007年12月.首诊初治T细胞NHL患者78例.治疗采用标准的CHOP、BACOP或CHOP-E方案,Ⅰ、Ⅱ期患者联合放疗.记录每位患者治疗前的年龄、性别、病理类型、临床分期、ECOG评分、最大肿瘤直径、结外受累部位数、有无B症状、LDH水平、132MG水平、国际预后指数(IPI)、治疗方案、治疗效果、无进展生存期(PFS)及总生存期(OS).应用免疫组化方法检测Ki-67的表达情况.应用SPSS 16.0软件进行统计学分析,探讨Ki-67表达与各临床因素之间的关系.结果:Kj-67低表达32例,高表达46例.Ⅰ、Ⅱ期与Ⅲ、Ⅳ期患者之间,最大肿瘤直径≤5cm与>5cm患者之间,LDH水平正常与升高患者之间的Ki-67表达水平有统计学差异(P<0.05).Ki-67表达水平与其它临床因素之间无统计学差异.Ki-67高表达患者的化疗有效率为78.3%,低表达患者为68.8%,两者之间无统计学差异(P=0.344).Ki-67低表达患者的PFS及OS较高表达患者长,并且有统计学差异(分别为P=0.036和P=0.029).多因素分析表明Ki-67是影响PFS及OS的独立预后因素.结论:Ki-67表达水平是T细胞NHL重要的预后因素,是对IPI的重要补充,两者相结合对预测患者的病情发展、制定个体化治疗策略有重要意义.     

自体造血干细胞移植治疗B细胞非霍奇金淋巴瘤的研究进展

非霍奇金淋巴瘤(non-hodgkin lymphoma,NHL)是一组起源于包括B-细胞、T细胞及NK细胞的异质性淋巴增殖性疾病.欧美国家B细胞淋巴瘤(B-NHL)约占80％ ～85％[1].我国B细胞淋巴瘤发生率约占NHL的61.6％～74.2％[24].B-NHL包括弥漫大B细胞淋巴瘤、套细胞淋巴瘤、滤泡性淋巴瘤等.NHL的治疗包括化疗、放疗、免疫治疗、放射免疫治疗及造血干细胞移植.近10多年来,由于CD20单克隆抗体(单抗)的应用和自体造血干细胞移植(autologous stem cell transplantation,ASCT)作为巩固治疗使得B-NHL的疗效明显提高[5-6].然而,自体造血干细胞移植是作为该病一线巩固还是待疾病复发后作为挽救性治疗仍待进一步明确.     

Disease characteristics of diffuse large B-cell lymphoma predicting relapse and survival after autologous stem cell transplantation: A single institution experience

While various tools such as the International Prognostic Index (IPI) and its derivatives exist for risk-stratification of diffuse large B-cell lymphoma (DLBCL) at diagnosis, patient and disease characteristics capable of predicting outcome after high-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT) are not clearly defined. We retrospectively analyzed medical records of 111 DLBCL patients (78 relapsed and 33 refractory) who underwent HDC/ASCT at our institution from 2010-2015. After a median follow-up time of 4.6 years (interquartile range [IQR] 2.2-8.1), the likelihood of 5-year progression-free survival (PFS) was 62.2% (95% CI, 53.4%-72.4%) and the likelihood of 5-year overall survival (OS) was 68.9% (95% CI, 60.7%-78.2%). More than three chemotherapy regimens prior to ASCT was the only variable associated with lower likelihood of PFS (P = .004) and OS (P = 0.026). Male gender and high IPI score at time of ASCT were also associated with lower likelihood of PFS (P = .043; P = .013). NCCN IPI and age-adjusted IPI at time of ASCT were not predictive of outcome following ASCT. Patients with refractory and relapsed disease had similar outcomes post-ASCT (P = .207 for PFS, P = .073 for OS).     

霍奇金淋巴瘤复发、难治的相关因素分析

 目的　探讨霍奇金淋巴瘤（HL）复发、难治的相关因素,分析复发、难治性HL患者的生存情况。方法　对62例HL患者的临床资料进行回顾性分析,对其临床特征、治疗方法等与复发、难治的关系进行相关性分析。结果　62例HL患者中,12例（19.35 %）为复发、难治性。病理类型（P＝0.026）、淋巴结区≥3个（P＝0.030）和大包块（P＝0.006）与复发、难治有关。复发、难治性HL患者中位生存时间为69.5个月（27～129个月）,复发、难治性HL及其他HL患者的5年总生存（OS）率分别为66.7 %和88.8 %,二组差异无统计学意义（P＝0.117）,无事件生存（EFS）率分别为52.4 %和87.9 %,差异有统计学意义（P＝0.006）。结论　HL的病理类型、淋巴结区≥3个和大包块与复发、难治关系密切,同时,短期（<1年）内复发是复发、难治性HL患者的不良预后因素,值得关注。     

Autologous hematopoietic stem-cell transplantation for relapsed or refractory Hodgkin's disease in children and adolescents.

PURPOSE: To determine the treatment outcome and clinical factors that are of prognostic significance for children and adolescents with relapsed or refractory Hodgkin's disease (HD) who received treatment with high-dose chemotherapy and autologous hematopoietic stem-cell transplantation (HSCT). PATIENTS AND METHODS: Fifty-three consecutive children and adolescents 21 years of age or younger with relapsed or refractory HD underwent HSCT. RESULTS: At day 100 after transplantation, 29 patients (55%) were in a complete remission or maintained a continuous complete response, six (11%) had a partial response, and 11 (21%) failed to respond or had progressive disease. The failure-free survival (FFS) at 5 years was 31%, and overall survival was 43%. Twenty-one patients died of progressive HD, and nine died secondary to transplantation-related complications, including two secondary leukemias. Prognostic factors important for FFS were normal pretransplantation lactate dehydrogenase levels (5-year FFS = 42%), compared with patients with elevated LDH levels (5-year FFS = 0%) (P < .001), and disease sensitivity at the time of HSCT with FFS in untreated relapse, sensitive disease, and resistant disease 44%, 35%, and 9%, respectively (P = .06). There was no statistically significant difference in FFS or overall survival between age subgroups that were analyzed (< 13, 13 to 18, 19 to 21) or in comparison with an adult cohort. CONCLUSION: HSCT is an effective treatment modality that can result in long-term cures and should be considered for children and adolescents with relapsed HD.     

Treatment of Relapsed or Refractory Aggressive Non-Hodgkin Lymphoma with Two Ifosfamide-Based Regimens,IMVP and ICE

Abstract

We report the outcomes of 45 patients with relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL) treated with a combination of ifosfamide, carboplatinum and etoposide (ICE) and 28 patients treated with a combination of ifosfamide, methotrexate and etoposide (IMVP) during two 5-year periods. The response rate (RR) to ICE was 47%, 2-year overall survival (OS) 31% and 2-year event-free survival (EFS) 22%. These results were similar to those obtained with IMVP (RR 39%, 2-year OS 23%, 2-year EFS 13%; p=0.355 for RR, 0.275 for OS, 0.668 for EFS). Higher IPI scores and refractoriness to treatment were negative prognostic factors, immunophenotype (B vs. T) had no influence on prognosis. Changing from IMVP to ICE does not substantially improve the outcome of patients with relapsed or refractory aggressive NHL. Patients with relapsed/refractory aggressive B-NHL do not have a superior out-come in comparison to those with T-NHL if treated with chemotherapy alone.     

含美罗华联合方案治疗复发耐药B细胞性非霍奇金淋巴瘤

背景与目的:复发或耐药的B细胞性非霍奇金淋巴瘤(non-Hodgkin slymphoma,NHL)预后不良,二线方案化疗远期生存差;抗CD20单克隆抗体美罗华(rituximab)与CHOP或类似方案联合作为一线方案治疗初治侵袭性淋巴瘤可提高远期生存率,但在二线治疗中的作用尚未确定。本研究初步探讨含美罗华联合方案治疗复发耐药B细胞性NHL的近期疗效和不良反应的情况。方法:中山大学肿瘤防治中心近年应用含美罗华方案治疗35例复发耐药NHL患者,其中男性19例,女性16例,中位年龄53.5岁。PS评分0～1分33例(94.3%)。IPI评分0～1分20例(57.1%),2分7例(20.0%),3分4例(11.4%),4～5分4例(11.4%);病理类型以弥漫大B细胞性为主(23例,占65.7%)。所有患者都接受含美罗华的治疗,每疗程前1天应用,剂量375mg/m2,二、三线挽救化疗方案包括EPOCH、CHOP、DHAP、DICE、IMVP-16和FND等。结果:35例患者中单用美罗华治疗者5例,美罗华联合化疗30例,共化疗102疗程。32例可评价客观疗效,有效率68.8%(22/32),完全缓解(CR)13例(40.6%),3例患者在含美罗华方案治疗后接受局部放疗获CR,3例患者在挽救方案治疗后加用造血干细胞移植获CR。主要不良反应为胃肠道反应、骨髓抑制、脱发等,加用美罗华治疗主要增加畏寒、发热等输注相关反应(5例)。中位随访时间12.5个月(3～69个月),失访2例,全组死亡10例(9例死于疾病进展,1例死于重症乙型性肝炎),中位无进展生存期(PFS)11.8个月(3～33个月)。总的1、2、3年生存率分别为72.9%、62.8%和62.8%。结论:含美罗华方案治疗复发耐药的B细胞NHL有效率高、不良反应可以耐受,值得在更大宗病例中作进一步研究。     

High-dose chemotherapy followed by autologous stem cell transplantation for relapsed or refractory Hodgkin lymphoma: prognostic features and outcomes

Between January 1990 and April 2001, 115 patients received high-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) for relapsed or refractory Hodgkin lymphoma (HL). With a median follow-up of 58 months (range, 1 - 175 months), 5-year progression-free survival (PFS) and overall survival (OS) were 46% and 58%, respectively. Twelve patients with primary refractory disease had a 5-year PFS of 41% and OS of 58%, not significantly different from those of the remaining cohort. Early and overall regimen related mortality were 7% and 16%, respectively. Male gender (P = 0.04) and a time to relapse (TTR) < 12 months (P = 0.03) were associated with decreased OS by univariate analysis. In multivariate analysis, TTR < 12 months remained statistically significant (P = 0.04). We have confirmed that HDT and ASCT result in long-term survival for a proportion of patients with relapsed or refractory HL. All patients, including those with primary refractory disease, benefited from HDT and ASCT.     

Response to Second-line Therapy Defines the Potential for Cure in Patients With Recurrent Diffuse Large B-Cell Lymphoma: Implications for the Development of Novel Therapeutic Strategies

BackgroundPatients with diffuse large B-cell lymphoma (DLBCL) who are not cured by initial therapy sometimes experience disease-free survival after autologous stem cell transplantation. Chemotherapy responsiveness before transplantation is a major predictor of outcome. Patients not responding to second-line regimens may receive third-line therapy in the hopes of achieving response, but outcome data are limited.Patients and MethodsWe identified patients with relapsed or refractory DLBCL at Weill Cornell Medical Center for whom data on responses to second-line chemotherapy were available.ResultsA total of 74 patients with relapsed or refractory DLBCL who underwent second-line chemotherapy between 1996 and 2007 were identified. Of these patients, 27 (36%) did not respond. The median overall survival of nonresponding patients was 4 months, and only 1 patient (4%) survived for 1 year. The choice of third-line aggressive chemotherapy instead of less intensive approaches did not confer a survival benefit.ConclusionOur data demonstrate that patients with recurrent DLBCL not responding to second-line chemotherapy demonstrate dismal outcomes. Trials of novel regimens should be prioritized as management strategies for these patients. Our data provide an important benchmark in the evaluation of the potential clinical value of such approaches.     

Clinical outcome after autologous transplantation in non-Hodgkin's lymphoma patients with high international prognostic index (IPI)

Background: Dose intensification and autologous stem cell transplantation as front-line therapy in non-Hodgkin's lymphoma patients (NHL) is a matter for debate, although preliminary data suggest a role for it in patients at high risk of resistance or relapse according to the international prognostic index (IPI).Purpose and study design: To compare retrospectively the clinical outcome of two cohorts of NHL patients with high-risk IPI treated with MACOP-B for 12 weeks (38 patients) or high-dose chemotherapy (44 patients) including eight weeks of MACOP-B, one or two intensification cycles with mitoxanthrone, dexamethasone, high-dose ara-C and finally BEAM chemotherapy with autologous hemopoietic progenitor cell transplantation.Results: The actuarial estimate of event (progression, relapse or death)-free survival (EFS) at three years was better (58% vs. 41%, P = 0.08) for patients treated with the intensive regimen even though the overall survival did not show a statistically significant difference (63% vs. 50%, P = 0.27). Multivariate analysis showed that the high-dose chemotherapy program was the only independent variable correlating with a reduction in the event rate.Conclusion: Early autologous stem-cell transplantation might improve the clinical outcome of high-risk patients according to IPI.     

自体干细胞移植治疗T细胞淋巴瘤31例临床分析

目的 探讨自体干细胞移植治疗T细胞淋巴瘤的疗效和其预后因素.方法 回顾性分析31例给予自体干细胞移植治疗的T细胞淋巴瘤的临床资料,观察3年总生存率和无进展生存率,分析一般状况(PS)、乳酸脱氢酶(LDH)、移植前状况、分期、外周T细胞淋巴瘤预后指数(PIT)评分对生存的影响.结果 全组中位随访时间为28(5～68)个月...     

The International Prognostic Factors Project score for advanced Hodgkin's disease is useful for predicting outcome of autologous hematopoietic stem cell transplantation.

BACKGROUND: The International Prognostic Factors Project on Advanced Hodgkin's Disease developed a seven-factor prognostic score consisting of serum albumin, hemoglobin, gender, stage, age, leukocytosis and lymphocytopenia for newly diagnosed Hodgkin's disease patients who receive chemotherapy. The purpose of this study was to determine whether this prognostic score would also be useful for Hodgkin's disease patients undergoing autologous hematopoietic stem cell transplantation. PATIENTS AND METHODS: We performed a retrospective review of 379 patients who had autologous transplants for Hodgkin's disease, at the University of Nebraska Medical Center between October 1984 and December 1999. Multivariate analysis was performed to determine whether the prognostic factors identified by the International Prognostic Factors Project adversely influenced event-free survival (EFS) or overall survival (OS). RESULTS: Low serum albumin, anemia, age and lymphocytopenia were associated with poorer EFS and OS. Gender, stage and leukocytosis were not associated with significantly poorer outcomes. Estimated 10-year EFS was 38%, 23% and 7% for patients with 0-1, 2-3 or > or =4 of the adverse prognostic characteristics identified by the International Prognostic Factors Project, respectively. CONCLUSIONS: The prognostic score for advanced disease is also useful for relapsed and refractory Hodgkin's disease patients undergoing high-dose therapy followed by autologous hematopoietic stem cell transplantation.