Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin's disease before intensive therapy and autologous bone marrow transplantation.
OBJECTIVE
To evaluate the efficacy of carmustine (BCNU), etoposide, cytarabine (Ara-C), and melphalan (mini-BEAM) as salvage therapy in patients with relapsed or refractory Hodgkin's disease who were potentially eligible to undergo intensive therapy and autologous bone marrow transplantation (ABMT).


METHODS
Forty-four patients with refractory or relapsed Hodgkin's disease after front-line combination chemotherapy referred for consideration of ABMT were treated with mini-BEAM (BCNU 60 mg/m2 on day 1, etoposide 75 mg/m2 on days 2 to 5, Ara-C 100 mg/m2 twice per day on days 2 to 5, and melphalan 30 mg/m2 on day 6) to maximum response. Eleven patients were refractory to primary chemotherapy. Twenty-three patients were treated in first relapse and 10 in second or subsequent relapse; 21 received mini-BEAM as their first salvage regimen. Patients were restaged to determine disease status immediately before intensive therapy and transplant.


RESULTS
The overall response rate was 84% (exact 95% confidence interval [CI], 70% to 92%), with a complete response (CR) rate of 32% (95% CI, 20% to 47%) and a partial response (PR) rate of 52%. No treatment-related deaths were observed. Myelosuppression was the major toxicity. Almost all patients required platelet transfusions. Eighty-four percent were given RBC transfusions, and 54% required intravenous antibiotics for fever while neutropenic.


CONCLUSIONS
Mini-BEAM is a safe and effective regimen for treatment of refractory or relapsed Hodgkin's disease. Further studies are required to determine if responding patients have improved disease-free survival (DFS) after intensive therapy and ABMT.
Colwill
R
R
University of Toronto Autologous Bone Marrow Transplant Program, Toronto Hospital, Canada.
Crump
M
M
Couture
F
F
Danish
R
R
Stewart
A K
AK
Sutton
D M
DM
Scott
J G
JG
Sutcliffe
S B
SB
Brandwein
J M
JM
Keating
A
A
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002330:Carmustine / Q000009:adverse effects / Q000627:therapeutic use; D016001:Confidence Intervals; D003422:Critical Care; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use; D017707:Erythrocyte Transfusion; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000532:radiotherapy / Q000628:therapy; D006801:Humans; D008297:Male; D008558:Melphalan / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D017713:Platelet Transfusion; D011034:Podophyllotoxin / Q000009:adverse effects / Q000627:therapeutic use; D011300:Preoperative Care; D011379:Prognosis; D012008:Recurrence; D016879:Salvage Therapy; D013997:Time Factors
D003561:Cytarabine; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine