Long-term outcome of Hodgkin disease patients following high-dose busulfan, etoposide, cyclophosphamide, and autologous stem cell transplantation.
Busulfan (Bu)-based preparative regimens have not been extensively investigated in Hodgkin disease (HD). The purposes of this study were to investigate the toxicity and efficacy of a novel preparative regimen of Bu 14 mg/kg, etoposide 50-60 mg/kg, and cyclophosphamide 120 mg/kg in patients with primary refractory and relapsed HD. One hundred twenty-seven patients with a median age of 33 years (range, 14-67 years) underwent transplantation. The regimen was well tolerated, with 5.5% treatment-related mortality at 100 days after transplantation. With a median follow up of 6.7 years, the 5-year progression-free survival was 48 +/- 5%, and the 5-year overall survival was 51 +/- 5%. A Cox proportional hazards model identified refractory disease at time of transplantation as the only significant factor affecting relapse and overall survival, whereas disease bulk >10 cm affected overall survival. Five patients died between 5.3 and 9.3 years of late complications, including secondary myelodysplasia or acute myeloid leukemia, secondary solid malignancies, and pulmonary toxicity. This novel Bu regimen is comparable to other radiation-free preparative regimens in its effectiveness in the control of HD and with a low-risk of early treatment-related mortality.
Wadehra
Navin
N
Division of Hematology and Oncology, The Ohio State University Hospitals, Columbus, Ohio, USA.
Farag
Sherif
S
Bolwell
Brian
B
Elder
Patrick
P
Penza
Sam
S
Kalaycio
Matt
M
Avalos
Belinda
B
Pohlman
Brad
B
Marcucci
Guido
G
Sobecks
Ronald
R
Lin
Thomas
T
Andrèsen
Steven
S
Copelan
Edward
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000401:mortality; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D047368:Tumor Burden
D005047:Etoposide; D003520:Cyclophosphamide; D002066:Busulfan