Second autologous stem cell transplant for multiply relapsed Hodgkin's disease.
Therapeutic options for patients with Hodgkin's disease who relapse after high-dose chemotherapy with autologous stem cell support are limited. Salvage chemotherapy is not curative, and allogeneic stem cell transplantation in this setting is associated with mortality rates of 40-65%. We report our institution's experience with second autologous transplants in this patient population. Five patients (median age 36) with relapsed Hodgkin's disease underwent a second autologous stem cell transplant at a median of 66 months after first transplant. Four patients received CBV, and one patient received BuCy as conditioning. Neutrophil and platelet engraftment occurred by days +10 and +16, respectively. All patients achieved a complete response, and no relapses have occurred after a median follow-up of 42 months. All four patients who received CBV developed interstitial pneumonitis, and two patients died of pulmonary complications 37 and 48 months following second transplant. Three patients remain alive and disease-free 41, 42 and 155 months after second transplant. These data indicate that second autologous transplantation should be considered for selected patients who relapse after a prolonged response to first autologous transplant. However, BCNU pneumonitis is the major toxicity in patients who have undergone previous mantle radiation and received busulfan with first transplant.
Lin
T S
TS
Arthur James Cancer Hospital and Richard Solove Research Institute at The Ohio State University, Bone Marrow Transplant Program, Division of Hematology and Oncology, Columbus, OH 43210, USA.
Avalos
B R
BR
Penza
S L
SL
Marcucci
G
G
Elder
P J
PJ
Copelan
E A
EA
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000633:toxicity; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007700:Kinetics; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy; D014182:Transplantation, Autologous / Q000379:methods