Dose intensification with autologous stem cell transplantation in relapsed and resistant Hodgkin's disease.
OBJECTIVE
Patients affected by Hodgkin's disease (HD) resistant to induction therapy or who have a brief duration of first remission have a poor outcome.


METHODS
We retrospectively reviewed the clinical data of 28 patients affected by Hodgkin's disease who relapsed 6 to 24 months from completion of treatment (14 patients) or who were refractory to first-line therapy or relapsed very early (14 patients). All the 28 patients were treated with salvage chemotherapy plus a conditioning regimen followed by peripheral blood stem cell transplant (PBCST) or autologous bone marrow transplant (ABMT).


RESULTS
At a median follow-up of 35.5 months (range 14-119), of the 14 patients responding to first-line therapy but who relapsed > 6 months off therapy, 10 (72%) are alive, well and in complete remission (CR), 2 (14%) are alive with disease at 39 and 83 months from transplant, and 2 (14%) died 26 and 63 months after their transplant from acute myeloid leukemia and HD, respectively. At a median follow-up of 39 months, the overall survival (OS) is 68% and the event-free survival (EFS) is 56%. At a median follow-up of 30 months (1-98), of the 14 patients refractory to first-line therapy or who relapsed very early, 9 (64%) are alive in CR, 1 (7%) is alive with disease and 4 (29%) have died of their disease (3 patients) or myelodysplastic syndrome (1 patient). The OS is 58% and the EFS is 52%. There are no statistically significant differences in terms of OS and EFS between the two groups of patients.


CONCLUSIONS
Our study shows that salvage chemotherapy followed by a conditioning regimen and autotransplant is an effective, feasible and well-tolerated scheme of therapy not only for patients with HD who relapse after first-line treatment, but also for those resistant to first-line treatment.
Anselmo
Anna Paola
AP
Dipartimento Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", via Benevento 6, 00161 Rome, Italy. anselmo@bce.uniroma1.it
Cavalieri
Elena
E
Meloni
Giovanna
G
Alimena
Giuliana
G
Cantonetti
Maria
M
Maurizi Enrici
Riccardo
R
Tosti
Maria Elena
ME
Falchetto Osti
Mattia
M
Gianfelici
Valentina
V
Mandelli
Franco
F
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000401:mortality; D033581:Stem Cell Transplantation / Q000401:mortality*; D016019:Survival Analysis; D014182:Transplantation, Autologous / Q000401:mortality