title: Results of CAV regimen (CCNU, melphalan, and VP-16) as third-line salvage therapy for Hodgkin's disease.
abstract: BACKGROUND
  A prospective study was conducted to assess the efficacy and toxicity of a salvage regimen consisting of CCNU, Melphalan, and VP-16 (CAV) given at 28-day intervals in patients with Hodgkin's disease (HD) relapsing after primary therapy or refractory to the alternating MOPP/ABVD regimen.
  
  
  METHODS
  This study included 58 patients (median age: 34 years), with resistant or relapsing HD. Primary therapy had consisted of alternating MOPP/ABVD (81%) or MOPP alone (19%); 38% of patients were relapsing from prior complete remission (CR) while 62% had resistant disease. Extranodal disease was present in 55% and B-symptoms in 72% of patients; one-fifth had bulky disease and/or bone marrow involvement. The CAV was used as first salvage in half of the patients.
  
  
  RESULTS
  Complete remission was obtained in 17 patients (29%); unfavorable factors for CR in univariate analysis were the presence of bulky disease and the failure to achieve CR with prior therapy. Nine patients (53% of remitters) have subsequently relapsed with a 10-month median duration of CR. The 3-year overall survival after CAV was 25% with an 18-month median survival; significant differences in survival were found according to the extent of disease, the presence of B-symptoms and the HD status (prior sensitive or resistant disease, first or subsequent relapse). Seven patients are long-term remitters (12%), and one of them has been given high-dose chemotherapy and autologous bone marrow transplantation at relapse after CAV. The CAV toxicity was mostly hematological; severe pancytopenia occurred in six cases with two cases of fatal infections and one of fatal hemorrhage.
  
  
  CONCLUSIONS
  CAV therapy was moderately effective as third-line salvage in patients with HD resistant to alternating MOPP/ABVD or previously given two different regimens for relapse; the toxicity was mostly hematological and supportive therapy was needed in one-third of the patients.
authors.affiliation: Cattedra di Ematologia, Università di Pavia, Policlinico San Matteo IRCCS, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Brusamolino
authors.forename: E
authors.initials: E
authors.lastname: Orlandi
authors.forename: A
authors.initials: A
authors.lastname: Canevari
authors.forename: E
authors.initials: E
authors.lastname: Morra
authors.forename: G
authors.initials: G
authors.lastname: Castelli
authors.forename: E P
authors.initials: EP
authors.lastname: Alessandrino
authors.forename: G
authors.initials: G
authors.lastname: Pagnucco
authors.forename: P
authors.initials: P
authors.lastname: Bernasconi
authors.forename: C
authors.initials: C
authors.lastname: Astori
authors.forename: M
authors.initials: M
authors.lastname: Lazzarino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004351:Drug Resistance; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D010198:Pancytopenia / Q000139:chemically induced; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy; D015996:Survival Rate; D014747:Vinblastine; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D008130:Lomustine; D003606:Dacarbazine; D004317:Doxorubicin; D008558:Melphalan; D011241:Prednisone