INDEX OF PRETREATMENT INTENSITY PREDICTS OUTCOME OF HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS PROGENITOR-CELL TRANSPLANTATION IN CHEMOSENSITIVERELAPSE OF HODGKINS-DISEASE

Purpose: To identify prognostic factors in patients with chemo sensiti ve relapsed Hodgkin's disease treated by high-dose chemotherapy with a utologous progenitor cell transplantation (HDC) and to compare the dur ation of treatment-free remission prior to HDC with the progression-fr ee survival after HDC in individual patients. Patients and methods: Fo rty-five consecutive patients were analyzed retrospectively. We devise d an index of pretreatment intensity (IPTI) based number of different chemo- and radiotherapy regimens given between diagnosis and HDC and o n the duration of disease. Results. With a median follow-up of 47 mont hs the posttransplant event-free survival (EFS) was 44% and the overal l survival (GAS) was 62% at four years. The IPTI allowed to discrimina te between a low and a high-risk group with a four-year post-transplan t EFS of 66% and 11% and a OAS of 87% and 28%, respectively (P = 0.000 1). Of the 39 patients with sufficient follow-up after HDC, post-trans plant EFS lasted on average greater than or equal to 18.5 months longe r than the pretransplant treatment-free remission. Conclusions. HDC wi th the CBV regimen confers significant benefit to patients with chemos ensitive relapsed Hodgkin's disease. The IPTI may help to select patie nts with a good response to HDC and to identify poor prognosis patient s suitable for experimental protocols or palliative care only.