Journal Article

Autologous stem cell transplantation followed by consolidation chemotherapy for relapsed or refractory Hodgkin's lymphoma

Bolaños-Meade, J, Akpek, G, Fenton, R, Badros, A, Ratterree, B, Guo, C, Gojo, I, Hakimian, R, Natt, S, Heyman, M, Withers, T, Kiggundu, E, Sarkodee-Adoo, C, Meisenberg, B, Mannuel, H, Phillips, G L, Ruehle, K, Rapoport, A P, Tricot, G, Takebe, N

2004

Overview

Relapse remains a major cause of treatment failure after autotransplantation (auto-PBSCT) for Hodgkin's disease (HD). The administration of non-crossresistant therapies during the post-transplant period may delay or prevent relapse. We prospectively studied the role of consolidation chemotherapy (CC) after auto-PBSCT in 37 patients with relapsed or refractory HD. Patients received high-dose gemcitabine-BCNU-melphalan and auto-PBSCT followed by involved-field radiation and up to four cycles of the DCEP-G regimen, which consisted of dexamethasone, cyclophosphamide, etoposide, cisplatin, gemcitabine given at 3 and 9 months post transplant alternating with a second regimen (DPP) of dexamethasone, cisplatin, paclitaxel at 6 and 12 months post transplant. The probabilities of event-free survival (EFS) and overall survival (OS) at 2.5 years were 59% (95% CI=42-76%) and 86% (95% CI=71-99%), respectively. In all, 17 patients received 54 courses of CC and 15 were surviving event free (2.5 years, EFS=87%). There were no treatment-related deaths during or after the CC phase. Post-transplant CC is feasible and well tolerated. The impact of this approach on EFS should be evaluated in a larger, randomized study.

• Publisher: Nature Publishing Group
• Subject: Adolescent / Adult / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Autografts / Biological and medical sciences / Bone marrow, stem cells transplantation. Graft versus host reaction / Cancer / Care and treatment / Chemotherapy / Cisplatin / Cisplatin - administration & dosage / Consolidation / Cyclophosphamide / Cyclophosphamide - administration & dosage / Deoxycytidine - administration & dosage / Deoxycytidine - analogs & derivatives / Dexamethasone / Dexamethasone - administration & dosage / Diagnosis / Etoposide / Etoposide - administration & dosage / Female / Gemcitabine / Health aspects / Hematologic and hematopoietic diseases / Hematopoietic Stem Cell Transplantation - methods / Hematopoietic Stem Cell Transplantation - mortality / Hodgkin Disease - mortality / Hodgkin Disease - therapy / Hodgkin's disease / Hodgkin's lymphoma / Humans / Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis / Lymphoma / Male / Medical sciences / Melphalan / Middle Aged / Paclitaxel / Patient outcomes / Patients / Radiation / Salvage Therapy - methods / Salvage Therapy - mortality / Secondary Prevention / Stem cell transplantation / Stem cells / Survival / Survival Analysis / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Transplantation / Transplantation, Autologous / Transplants & implants