Brazilian experience using high-dose sequential chemotherapy followed by autologous hematopoietic stem cell transplantation for relapsed or refractory Hodgkin lymphoma.
OBJECTIVE
We evaluate the effectiveness and toxicity of high-dose sequential chemotherapy (HDS) as salvage therapy in patients with advanced-stage Hodgkin lymphoma.


METHODS
We performed a retrospective analysis on 77 patients receiving HDS between 1998 and 2006. Patients enrolled were in disease progression or relapsed disease, or did not achieve a complete remission after first-line treatment. HDS consisted of the sequential administration of cyclophosphamide and granulocyte colony-stimulating factor with stem cell harvesting, followed by methotrexate plus vincristine and etoposide.


RESULTS
The majority of patients had stage III/IV (64%) and B symptoms (71.4%). Disease status improvement after HDS was observed in 24 of 57 patients (42%) previously in disease progression or relapse. HDS-related deaths occurred in 8 of 77 patients (10.4%). Four patients (5.2%) developed acute myeloid leukemia/myelodysplastic syndrome. Overall, disease-free and progression-free survival was 27%, 57%, and 25%, respectively.


CONCLUSIONS
Despite the treatment-related mortality, HDS is feasible, with satisfactory response rates, even in patients with poor prognosis.
Duarte
Bruno K L
BK
Bone Marrow Transplantation Unit, University of Campinas - UNICAMP, São Paulo, Brazil.
Valente
Isabella
I
Vigorito
Afonso C
AC
Aranha
Francisco J P
FJ
Oliveira-Duarte
Gislaine
G
Miranda
Eliana C M
EC
Lorand-Metze
Irene
I
Pagnano
Katia B
KB
Delamain
Marcia
M
Marques Junior
José F
JF
Brandalise
Silvia R
SR
Nucci
Márcio
M
De Souza
Carmino A
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014182:Transplantation, Autologous