title: Single and double autotransplants for relapsing/refractory Hodgkin's disease: results of two consecutive trials.
abstract: To evaluate a strategy of one cycle of dose-intensive chemotherapy for patients with Hodgkin's disease in sensitive relapse and two cycles for those with refractory disease, 122 patients received dose-intensive chemotherapy followed by autotransplant in two consecutive studies. Patients with refractory disease were offered a second transplant with different conditioning in the absence of progression or excessive toxicity. CR was present after treatment in 46% while 16% died in the peritransplant period. Of 41 patients with primary refractory disease and 42 with refractory relapse, 24 and 21 respectively received a second cycle. Of these 45 refractory patients, 12 were in CR and 11 in PR after the first cycle and 10 of these 11 in PR achieved a durable CR with the second transplant. The CR rate is 37% in patients with refractory relapse and 19% in those with primary refractory disease. At a median follow-up of 4 years, median survival is 45 months. Progression-free survival of the refractory patients who could receive a second cycle was similar to that of patients with sensitive disease. A sequential transplant strategy is feasible. A subgroup of patients with refractory disease can achieve long-term survival after sequential BMT.
authors.affiliation: Division of Oncology and Hematology, New York Medical College, Valhalla 10595, USA.
authors.forename: T
authors.initials: T
authors.lastname: Ahmed
authors.forename: D E
authors.initials: DE
authors.lastname: Lake
authors.forename: M
authors.initials: M
authors.lastname: Beer
authors.forename: E J
authors.initials: EJ
authors.lastname: Feldman
authors.forename: R A
authors.initials: RA
authors.lastname: Preti
authors.forename: K
authors.initials: K
authors.lastname: Seiter
authors.forename: L
authors.initials: L
authors.lastname: Helson
authors.forename: A
authors.initials: A
authors.lastname: Mittelman
authors.forename: R
authors.initials: R
authors.lastname: Kancherla
authors.forename: J
authors.initials: J
authors.lastname: Ascensao
authors.forename: T
authors.initials: T
authors.lastname: Akhtar
authors.forename: P
authors.initials: P
authors.lastname: Cook
authors.forename: R
authors.initials: R
authors.lastname: Goldberg
authors.forename: M
authors.initials: M
authors.lastname: Coleman
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D012074:Remission Induction; D019233:Retreatment; D016879:Salvage Therapy; D016019:Survival Analysis; D013852:Thiotepa / Q000008:administration & dosage / Q000009:adverse effects; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D003561:Cytarabine; D014747:Vinblastine; D013852:Thiotepa; D016190:Carboplatin; D008942:Mitoxantrone