title: Tandem high-dose chemotherapy and autologous stem cell transplantation in refractory/relapsed Hodgkin's lymphoma: a monocenter prospective study.
abstract: We designed a prospective study to evaluate the feasibility and efficacy of tandem high-dose chemotherapy (HDCT) in the treatment of refractory or relapsed Hodgkin's lymphoma (HL). Thirty-two patients were treated with salvage chemotherapy (IGEV, ifosfamide, gemcitabine, and vinorelbine) and chemo-sensitive patients received a first HDCT course with melphalan 200 mg/m(2) (MEL200) and a second BEAM course. The median time interval between the two HDCT courses was 66 days. The median number of reinfused CD34(+) cells was 4.7 x 10(6)/kg after MEL200 and 5.8 x 10(6)/kg after BEAM. The hematological reconstitution after both HDCT courses did not differ. No grade III or IV renal, hepatic, lung, cardiac, and neurological toxicity was observed. Severe (grade III and IV) oral mucositis was the most prominent complication affecting 60 and 50% of patients after MEL200 and BEAM, respectively. Fever of unknown origin occurred in 65 and 70% of patients after MEL200 and BEAM, respectively. One patient died from septic shock during the aplasia period following BEAM. In an intention-to-treat analysis, the overall response rate increased after each stage of protocol, ranging from 47% to 65% and 75% after IGEV, MEL200, and BEAM, respectively. Tandem HDCT is feasible and effective in patients with relapsed or refractory HL.
authors.affiliation: Department of Hematology and Medical Oncology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. luca.CASTAGNA@humanitas.it
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Massimo
authors.initials: M
authors.lastname: Magagnoli
authors.forename: Monica
authors.initials: M
authors.lastname: Balzarotti
authors.forename: Barbara
authors.initials: B
authors.lastname: Sarina
authors.forename: Licia
authors.initials: L
authors.lastname: Siracusano
authors.forename: Andrea
authors.initials: A
authors.lastname: Nozza
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Todisco
authors.forename: Stefania
authors.initials: S
authors.lastname: Bramanti
authors.forename: Rita
authors.initials: R
authors.lastname: Mazza
authors.forename: Filippo
authors.initials: F
authors.lastname: Russo
authors.forename: Inna
authors.initials: I
authors.lastname: Timofeeva
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002330:Carmustine / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D011034:Podophyllotoxin / Q000008:administration & dosage; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D014182:Transplantation, Autologous; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine; D000093542:Gemcitabine
chemical_list: D003561:Cytarabine; D003841:Deoxycytidine; D014747:Vinblastine; D005047:Etoposide; D011034:Podophyllotoxin; D008558:Melphalan; D000077235:Vinorelbine; D002330:Carmustine; D007069:Ifosfamide; D000093542:Gemcitabine