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Intensive therapy with cyclophosphamide, carmustine, etoposide +/-
cisplatin, and autologous bone marrow transplantation for Hodgkin's disease
in first relapse after combination chemotherapy [see comments]
DE Reece, JM Connors, JJ Spinelli, MJ Barnett, RN Fairey, HG Klingemann, SH Nantel, S O'Reilly, JD Shepherd and HJ Sutherland
Leukemia/Bone Marrow Transplantation Program of British Columbia, Vancouver
General Hospital, Canada.
The optimal timing in which to use intensive chemotherapy and autologous
bone marrow transplantation (BMT) in Hodgkin's disease (HD) is uncertain.
In 1985, we initiated a program in which this modality was used as the
initial salvage therapy in patients relapsing after combination
chemotherapy. Fifty-eight patients with HD in first relapse after primary
chemotherapy received conditioning with high-dose cyclophosphamide,
carmustine, etoposide (VP16-213) +/- cisplatin (CBV +/- P) followed by
autologous BMT. All but six of these patients were given a median of two
cycles of conventional chemotherapy +/- involved field radiation therapy
before CBV +/- P and autologous BMT. These measures were not used as a
means for patients selection; all patients receiving such therapy
ultimately were transplanted. The probability of nonrelapse mortality,
progression of HD, and progression-free survival post-BMT were calculated,
and prognostic factors for progression-free survival were evaluated using
the Cox proportional hazards method. Treatment-related deaths occurred in
only three patients. Thirteen patients have relapsed at a median 0.7 years
(range 0.1 to 3.5) post- BMT. At a median follow-up of 2.3 years (range 0.4
to 7.2), the actuarial progression-free survival is 64% (95% confidence
interval, 46% to 78%). In the statistical analysis, three similarly
weighted but independent prognostic factors were identified: "B" symptoms
at relapse, extranodal disease at relapse, and initial remission duration
of less than 1 year. Patients with no risk factors had a 3-year
progression-free survival of 100%, compared with 81% in patients with one
factor, 40% in those with two factors, and 0% in patients with all three
factors. CBV +/- P and autologous BMT is highly effective salvage therapy
for HD patients in a first relapse, particularly in the subset of patients
with less than two adverse factors. Therapy must be improved in the future
for patients with > or = 2 adverse factors.
Volume 83,
Issue 5,
pp. 1193-1199,
03/01/1994
Copyright © 1994 by The American Society of Hematology
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