title: Salvage chemotherapy with alternating MINE-ESHAP regimen in relapsed or refractory Hodgkin's lymphoma followed by autologous stem-cell transplantation.
abstract: BACKGROUND
  High-dose chemotherapy (HDT) followed by autologous stem-cell transplantation (ASCT) is considered the gold standard in the treatment of patients with relapsed or refractory Hodgkin's lymphoma (HL). However, the optimal salvage regimen has not yet been established.
  
  
  METHODS
  We retrospectively analyzed the efficacy and toxicity of MINE (mesna, ifosfamide, mitoxantrone, and etoposide) alternated with ESHAP (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin) in the treatment of 61 relapsed or refractory HL patients after ABVD-based chemotherapy.
  
  
  RESULTS
  Overall, 25 patients (41%) achieved a complete response (CR), 23 (38%) a partial response (PR), 4 (7%) a stable disease, and 8 (13%) progressed for an overall response rate of 79%. Response to first-line chemotherapy was the most important prognostic factor for response to MINE-ESHAP (P = 0.041). No grade 4 extrahematologic toxic effects or toxic deaths were observed. Adequate peripheral blood stem-cell collection was achieved in 56 of 59 (95%) mobilized patients. Overall survival and event-free survival after HDT and ASCT were significantly higher for patients achieving CR/PR in comparison with those refractory to MINE-ESHAP (46% and 35% versus 74% and 69%, respectively).
  
  
  CONCLUSIONS
  MINE-ESHAP results in a high response rate with acceptable toxicity in patients with HL having failed ABVD-based treatment.
authors.affiliation: Department of Hematology.
authors.forename: C
authors.initials: C
authors.lastname: Fernández de Larrea
authors.affiliation: Department of Hematology. Electronic address: cmarti@clinic.ub.es.
authors.forename: C
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Department of Hematology.
authors.forename: A
authors.initials: A
authors.lastname: Gaya
authors.affiliation: Department of Hematology.
authors.forename: A
authors.initials: A
authors.lastname: López-Guillermo
authors.affiliation: Department of Hematology.
authors.forename: M
authors.initials: M
authors.lastname: Rovira
authors.affiliation: Department of Hematology.
authors.forename: F
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Department of Hemotherapy, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Lozano
authors.affiliation: Department of Hematology.
authors.forename: F
authors.initials: F
authors.lastname: Bosch
authors.affiliation: Department of Hematology.
authors.forename: J
authors.initials: J
authors.lastname: Esteve
authors.affiliation: Department of Hematology.
authors.forename: B
authors.initials: B
authors.lastname: Nomdedeu
authors.affiliation: Department of Hematology.
authors.forename: E
authors.initials: E
authors.lastname: Montserrat
authors.affiliation: Department of Hematology.
authors.forename: E
authors.initials: E
authors.lastname: Carreras
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008935:Mitoguazone / Q000008:administration & dosage; D010507:Periodicity; D011241:Prednisone / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D033581:Stem Cell Transplantation / Q000379:methods*; D014182:Transplantation, Autologous; D017211:Treatment Failure; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D003561:Cytarabine; D014747:Vinblastine; D005047:Etoposide; D008935:Mitoguazone; D002945:Cisplatin; D007069:Ifosfamide; D011241:Prednisone