Evolution of outcomes in autologous stem cell transplantation for hodgkin lymphoma over 2 decades at King Hussein cancer center.

Autologous hematopoietic stem cell transplantation (auto-HCT) remains a cornerstone in relapsed Hodgkin lymphoma (HL), especially where access to novel agents is limited. We evaluated trends in outcomes after auto-HCT at King Hussein Cancer Center (KHCC) over two decades. We retrospectively analyzed adult HL patients who underwent auto-HCT between 2003 and 2020, divided into two eras: group A (2003-2015) and group B (2016-2020). Survival was estimated by Kaplan-Meier and compared by log-rank; prognostic factors were assessed with Cox regression. We identified 265 patients (group A: N = 149, 56%; group B: N = 116, 44%). The median age at transplant was 30.2 years (range 18.7-64). 109 (43%) had primary refractory disease.) With a median follow-up of 44 months (range 0.1-233.7), the 5-year OS and PFS were 64.4% and 46.7%, respectively. Compared to group A, patients in group B were more likely to receive ≥ 1 salvage regimen (54% vs. 40%, p = 0.027), receive GDP (gemcitabine, dexamethasone, cisplatin) (48% vs. 2.2%, p < 0.001), receive TEAM (thiotepa, etoposide, ara-C, melphalan) conditioning (20% vs. 6.5%, p < 0.001), and receive pembrolizumab at relapse (23% vs. 4.3%, p < 0.001), they were less likely to relapse post auto-HCT (35% vs. 55%, p = 0.003). Multivariate analysis identified younger age, CR at transplant, later transplant era, and longer remission duration after frontline therapy as independent predictors of improved survival (p = 0.01). Auto-HCT outcomes for HL at KHCC have improved significantly in the modern era. This reflects advances in salvage regimens, supportive care, reduced non-relapse mortality, and integration of immunotherapy for post-autoHCT relapses.