title: Long-term outcome of Hodgkin disease patients following high-dose busulfan, etoposide, cyclophosphamide, and autologous stem cell transplantation.
abstract: 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.
authors.affiliation: Division of Hematology and Oncology, The Ohio State University Hospitals, Columbus, Ohio, USA.
authors.forename: Navin
authors.initials: N
authors.lastname: Wadehra
authors.forename: Sherif
authors.initials: S
authors.lastname: Farag
authors.forename: Brian
authors.initials: B
authors.lastname: Bolwell
authors.forename: Patrick
authors.initials: P
authors.lastname: Elder
authors.forename: Sam
authors.initials: S
authors.lastname: Penza
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.forename: Belinda
authors.initials: B
authors.lastname: Avalos
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.forename: Guido
authors.initials: G
authors.lastname: Marcucci
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.forename: Thomas
authors.initials: T
authors.lastname: Lin
authors.forename: Steven
authors.initials: S
authors.lastname: Andrèsen
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
mesh_terms: 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
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide; D002066:Busulfan