title: Autologous stem cell transplantation followed by consolidation chemotherapy for relapsed or refractory Hodgkin's lymphoma.
abstract: Relapse remains a major cause of treatment failure after autotransplantation (auto-PBSCT) for Hodgkin's disease (HD). The administration of non-crossresistant therapies during the post-transplant period may delay or prevent relapse. We prospectively studied the role of consolidation chemotherapy (CC) after auto-PBSCT in 37 patients with relapsed or refractory HD. Patients received high-dose gemcitabine-BCNU-melphalan and auto-PBSCT followed by involved-field radiation and up to four cycles of the DCEP-G regimen, which consisted of dexamethasone, cyclophosphamide, etoposide, cisplatin, gemcitabine given at 3 and 9 months post transplant alternating with a second regimen (DPP) of dexamethasone, cisplatin, paclitaxel at 6 and 12 months post transplant. The probabilities of event-free survival (EFS) and overall survival (OS) at 2.5 years were 59% (95% CI=42-76%) and 86% (95% CI=71-99%), respectively. In all, 17 patients received 54 courses of CC and 15 were surviving event free (2.5 years, EFS=87%). There were no treatment-related deaths during or after the CC phase. Post-transplant CC is feasible and well tolerated. The impact of this approach on EFS should be evaluated in a larger, randomized study.
authors.affiliation: University of Maryland Greenebaum Cancer Center, Baltimore, MD 21201, USA. arapoport@umm.edu
authors.forename: A P
authors.initials: AP
authors.lastname: Rapoport
authors.forename: C
authors.initials: C
authors.lastname: Guo
authors.forename: A
authors.initials: A
authors.lastname: Badros
authors.forename: R
authors.initials: R
authors.lastname: Hakimian
authors.forename: G
authors.initials: G
authors.lastname: Akpek
authors.forename: E
authors.initials: E
authors.lastname: Kiggundu
authors.forename: B
authors.initials: B
authors.lastname: Meisenberg
authors.forename: H
authors.initials: H
authors.lastname: Mannuel
authors.forename: N
authors.initials: N
authors.lastname: Takebe
authors.forename: R
authors.initials: R
authors.lastname: Fenton
authors.forename: J
authors.initials: J
authors.lastname: Bolaños-Meade
authors.forename: M
authors.initials: M
authors.lastname: Heyman
authors.forename: I
authors.initials: I
authors.lastname: Gojo
authors.forename: K
authors.initials: K
authors.lastname: Ruehle
authors.forename: S
authors.initials: S
authors.lastname: Natt
authors.forename: B
authors.initials: B
authors.lastname: Ratterree
authors.forename: T
authors.initials: T
authors.lastname: Withers
authors.forename: C
authors.initials: C
authors.lastname: Sarkodee-Adoo
authors.forename: G L
authors.initials: GL
authors.lastname: Phillips
authors.forename: G
authors.initials: G
authors.lastname: Tricot
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003907:Dexamethasone / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy / Q000379:methods* / Q000401:mortality; D055502:Secondary Prevention; D016019:Survival Analysis; D014182:Transplantation, Autologous; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D005047:Etoposide; D003907:Dexamethasone; D003520:Cyclophosphamide; D002945:Cisplatin; D000093542:Gemcitabine