Early Failure of Induction Impacts Transplant Outcomes in Hodgkin Lymphoma Revealed Through A Longitudinal Nationwide Registry in Taiwan

Hodgkin lymphoma (HL) has favorable outcomes with frontline therapy; however, prognosis remains suboptimal in relapsed or refractory cases. Autologous stem cell transplantation (ASCT) is the standard of care in this setting, yet the prognostic impact of early failure of induction (EFI) chemotherapy has not been characterized in Asian populations. This nationwide, multicenter, retrospective longitudinal analysis evaluated the association between EFI and post-ASCT outcomes. Among 238 ASCT-treated patients, 46.6% occurred EFI and was associated with inferior 5-year overall survival (OS) compared to non-EFI (75% vs. 90%, p = 0.013). In multivariable Cox regression, EFI (hazard ratio [HR] 2.21, 95% confidence interval [CI] 1.07–4.58, p = 0.032) and Charlson comorbidity index >2 (HR 3.40, 95% CI 1.63–7.09, p = 0.001)independently predicted poorer OS. Restricted cubic spline modeling demonstrated a dose–response relationship between induction failure duration and mortality risk. These findings were confirmed through propensity score matching and inverse probability of treatment weighting analyses. Among patients who experienced relapse following their first transplantation, EFI remained an adverse prognostic factor (2-year OS, EFI vs. non-EFI: 59% vs. 82%, p = 0.049). This study addresses a crucial gap by providing insights into post-transplantation outcomes and informing future treatment strategies for patients with HL in Asian.