High lactate dehydrogenase level is associated with an adverse outlook in autografting for Hodgkin's disease.
Forty-two patients with relapsed or refractory Hodgkin's disease (HD) were treated with high-dose chemotherapy (BEAM regimen) followed by autologous bone marrow and/or peripheral blood progenitor cell (PBPC) rescue. There was one procedure-related death and the overall response rate at 6 months was 88% (95% confidence interval 78-98%). The 2 year overall and event-free survival was 81% (95% confidence interval 65-96%) and 74% (95% confidence interval 58-89%) respectively. Median follow-up was 33 months. The use of PBPC instead of marrow resulted in a significant shortening of the time to engraftment (P < 0.01). Multivariate analysis identified the pre-transplant LDH level as a highly significant factor in predicting overall survival (P = 0.007). The BEAM regimen is an effective conditioning schedule that is well tolerated but patients with a raised LDH at the time of transplant remain at high risk of early relapse and death due to disease.
Lumley
M A
MA
Birmingham Heartlands Hospital, Bordesley Green East, UK.
Milligan
D W
DW
Knechtli
C J
CJ
Long
S G
SG
Billingham
L J
LJ
McDonald
D F
DF
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002330:Carmustine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000097:blood / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D011034:Podophyllotoxin / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D003561:Cytarabine; D007770:L-Lactate Dehydrogenase; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine