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Blood, Vol. 93 No. 11 (June 1), 1999:
pp. 3632-3636
ASHAP: A Regimen for Cytoreduction of Refractory or Recurrent
Hodgkin's Disease
J. Rodriguez,
M.A. Rodriguez,
L. Fayad,
P. McLaughlin,
F. Swan,
A. Sarris,
J. Romaguera,
B. Andersson,
F. Cabanillas, and
F.B. Hagemeister
From the Department of Lymphoma and Myeloma, The University of Texas,
M.D. Anderson Cancer Center, Houston, Texas.
Patients with Hodgkin's disease, which is either refractory or
recurs after frontline chemotherapy with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone), ABVD
(doxorubicin, bleomycin, vinblastine, and dacarbazine), or
both regimens, generally have a poor prognosis. High-dose chemotherapy
with autologous marrow or stem cell rescue (ABMT) is now a widely used
salvage strategy in these patients. In this study, our objective was to determine the response rate to ASHAP (Adriamycin = doxorubicin, Solumedrol = methylprednisolone, High-dose Ara-C = cytosine
arabinoside, and Platinum = cisplatinum), in a group of patients with
Hodgkin's disease with such poor risk characteristics. The treatment
was intended as a brief tumor reducing program before ABMT. Fifty-six patients with diagnosed relapsed or primary refractory Hodgkin's disease underwent this treatment. The program consisted of the administration of two cycles of ASHAP chemotherapy (doxorubicin 10 mg/m2/d intravenous (IV) continuous infusion (CI) over 24 hours, days 1 to 4; methylprednisolone 500 mg/d IV over 15 minutes
daily for 5 days; cisplatinum 25 mg/m2/d IV CI over 24 hours, days 1 to 4; cytosine arabinoside 1.5 g/m2/d IV over
2 hours on day 5). After two courses of ASHAP the patients were
evaluated for response, including a gallium scan test. Patients with
progressive disease were taken off the study. Those with responding or
stable disease received a third course of ASHAP, followed by
consolidative treatment with ABMT. There were 19 complete responses
(34% CR), 20 partial responses (36% PR), and 17 treatment failures,
including 8 with minor responses and 9 with disease progression. Thus,
in total there were 39 responses out of 56 patients (CR + PR
= 70%). Myelosuppression was the main toxicity. There were no
deaths due to toxicity. At this time, 23 patients are alive. There were
31 deaths due to disease progression and 2 due to other causes. The
initial response to ASHAP before subsequent ABMT consolidation
treatment correlated with survival. All 17 patients in whom ASHAP
failed to achieve a response have died. The presence of B symptoms at
relapse, and a duration of response to the last regimen of  6 months,
predicted a poor response to ASHAP. A short program of treatment
with ASHAP is an effective tumor debulking approach in patients
previously treated with both or either ABVD and MOPP, before ABMT.
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