Intensive conditioning regimen of etoposide (VP-16), cyclophosphamide and carmustine (VCB) followed by autologous hematopoietic stem cell transplantation for relapsed and refractory Hodgkin's lymphoma

M Benekli, S L Smiley, T Younis, M S Czuczman, F Hernandez-Ilizaliturri, B Bambach, M Battiwalla, S Padmanabhan, P L McCarthy, T Hahn

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20 Scopus citations

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 languageEnglish (US)
Pages (from-to)613-9
Number of pages7
JournalBone Marrow Transplantation
Volume41
Issue number7
DOIs
StatePublished - 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

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