title: MiCMA: an alternative treatment for refractory or recurrent Hodgkin's disease.
abstract: BACKGROUND
  We determined the response rate to MiCMA (mitoxantrone, carboplatinum, methylprednisolone and aracytin) in a group of 29 patients with Hodgkin's disease (HD) and poor prognostic factors either resistant to first line or relapsing after conventional chemotherapy and subsequently evaluated the role of autologous stem-cell transplantation (ASCT) in these patients after MiCMA.
  
  
  METHODS
  The treatment was intended as a brief tumor debulking program before ASCT. Twenty-nine patients with primary refractory HD or relapsed HD were submitted to two courses of MiCMA (mitoxantrone 10 mg/m2 day 1; carboplatinum 100 mg/m2 days 1-4; aracytin 2 g/m2 day 5; methylprednisolone 500 mg/m2 days 1-5) and subsequently evaluated for response. Those with responding or stable disease, received one or two other courses of MiCMA followed by ASCT.
  
  
  RESULTS
  There were 10 complete responses (34% CR), 15 partial responses (52% PR) and 4 treatment failures with disease progression (14% PD). In total there were 25 evaluable responses out of 29 patients (86% CR + PR). Myelosuppression was the main toxicity of this treatment. At this time 20 patients (69%) are alive with a median follow-up of 26.5 months (7-100), 13 patients in CR (45%), 8 patients died, 7 of them from disease progression and one due to multi-organ failure, one patient is lost to follow-up. All but one of the patients who achieved CR after MiCMA are alive. Only the number of extranodal sites was found to predict a poor response to MiCMA.
  
  
  CONCLUSIONS
  A short pre-transplantation treatment with MiCMA is an effective tumor debulking approach in patients with refractory or relapsed HD.
authors.affiliation: Department of Hematology, Istituto di Semeiotica Medica, Universita' Cattolica Sacro Cuore Roma, Italia.
authors.forename: E O
authors.initials: EO
authors.lastname: La Barbera
authors.forename: P
authors.initials: P
authors.lastname: Chiusolo
authors.forename: L
authors.initials: L
authors.lastname: Laurenti
authors.forename: G
authors.initials: G
authors.lastname: Menichella
authors.forename: A L
authors.initials: AL
authors.lastname: Di Febo
authors.forename: N
authors.initials: N
authors.lastname: Piccirillo
authors.forename: E
authors.initials: E
authors.lastname: Sorà
authors.forename: R
authors.initials: R
authors.lastname: Marra
authors.forename: L
authors.initials: L
authors.lastname: Teofili
authors.forename: G
authors.initials: G
authors.lastname: Leone
authors.forename: S
authors.initials: S
authors.lastname: Sica
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D016190:Carboplatin; D008942:Mitoxantrone; D008775:Methylprednisolone