Abstract
Several high-dose therapy regimens are used for autologous hematopoietic stem cell transplantation (auto-HSCT) for relapsed and refractory Hodgkin's lymphoma (HL) with variable disease response. An intensified regimen of etoposide (VP-16) 2,400 mg/m(2), cyclophosphamide 7,200 mg/m(2) and carmustine (BCNU) 600 mg/m(2) (VCB) pre-auto-HSCT was developed to overcome disease recurrence. A total of 43 relapsed and refractory HL patients underwent auto-HSCT between January 1992 and December 2004. At day 100 there were 37 (86%) complete responses. A total of 40 patients survived beyond day 100, 14 of whom subsequently relapsed/progressed. At a median follow-up of 4.9 years (range 1.5-11.4 years), 26 patients (60%) are alive and disease free. Five-year actuarial event-free survival (EFS) was 53% (95% CI 35-70%) and median EFS was 5.9 years. Median progression-free and overall survivals have not been reached. EFS was reduced with an increasing number of prognostic factors (Karnofsky performance status, KPS <90, chemotherapy-resistant disease and >or=3 chemotherapy regimens prior to transplant <or=1 vs >or=2; P=0.049). Grade III-IV regimen-related toxicity was 9% (n=4). The 1-year cumulative incidence of interstitial pneumonitis (IP) was 36%, however only two patients died of IP complications. Disease progression was the most common cause of death (n=10, 23%). Intensive VCB is an effective and well-tolerated preparative regimen for relapsed and refractory HL auto-HSCT.
Original language | English (US) |
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Pages (from-to) | 613-9 |
Number of pages | 7 |
Journal | Bone Marrow Transplantation |
Volume | 41 |
Issue number | 7 |
DOIs | |
State | Published - Apr 2008 |
Keywords
- Adolescent
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols
- Carmustine
- Cyclophosphamide
- Disease-Free Survival
- Etoposide
- Female
- Graft Survival
- Hematopoietic Stem Cell Transplantation
- Hodgkin Disease
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- Transplantation Conditioning
- Transplantation, Autologous
- Treatment Failure
- Clinical Trial
- Journal Article