Phase II study of PEND chemotherapy in patients with refractory/relapsed Hodgkin lymphoma.
High-dose chemotherapy with autologous marrow or stem cell rescue (HDC/ASCT) is an effective strategy in patients with relapsed Hodgkin lymphoma. Various chemotherapy regimens have been used for cytoreduction prior to HDC/ASCT. In this study, our objective was to determine the response rate to PEND in a group of patients with relapsed Hodgkin lymphoma. Nineteen patients with relapsed or primary refractory Hodgkin lymphoma underwent treatment with the PEND regimen and received a median of 2 cycles (1 - 6 cycles). The PEND regimen builds on our prior results with ABDIC and consists of prednisone 40 mg/m2 orally (PO) daily x 5 days; etoposide 50 mg/m2 PO daily x 14 days; mitoxantrone 5 mg/m2/d IV, days 1 and 3; and DTIC 200 mg/m2/d intravenous continuous infusion (CIV) over 24 h, days 1 to 5, via central venous catheter. The treatment was given every 28 days. There were 3 complete responses (16%) and 10 partial responses (53%) yielding a total response rate of 69% (95% C.I. 43%, 87%). Myelosuppression was the predominant toxicity; no deaths were due to toxicity. After achieving maximum response to PEND, 10 eligible patients received a consolidative treatment with HDC/ASCT. All 6 patients who did not respond to PEND died from disease progression whereas 5 of 13 responders were alive after 10 years of follow-up (3 without disease). There were 11 deaths due to disease progression; three from other causes. The initial response to PEND before subsequent ASCT consolidation treatment appears to be associated with survival. All patients who failed to achieve a response have died. We conclude that PEND is an effective treatment strategy in Hodgkin lymphoma patients previously treated with both ABVD and MOPP.
Ibrahim
Dina
D
Lymphoma and Myeloma Service, Division of Hematology/Oncology, Wayne State University, Detroit, Michigan, USA.
Smith
Mitchell R
MR
Varterasian
Mary
M
Karanes
Chatchada
C
Millenson
Michael
M
Yeslow
Gwen
G
Pemberton
Pamela
P
Lai
Ping
P
Abrams
Judith
J
Al-Katib
Ayad
A
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000633:toxicity; D003606:Dacarbazine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008942:Mitoxantrone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis
D005047:Etoposide; D003606:Dacarbazine; D008942:Mitoxantrone; D011241:Prednisone