HIGH-DOSE CHEMOTHERAPY FOLLOWED BY AUTOLOGOUS HEMATOPOIETIC RESCUE FOR HODGKINS-DISEASE PATIENTS FOLLOWING FIRST RELAPSE AFTER CHEMOTHERAPY

Background: The best results of conventional-dose salvage chemotherapy for Hodgkin's disease have been reported after first relapse. We eval uated the results of high-dose chemotherapy and autologous hematopoiet ic rescue for Hodgkin's disease patients who had relapsed from an init ial chemotherapy-induced complete remission. Patients and methods: Eig hty-five patients received high-dose cyclophosphamide, carmustine, and etoposide (CBV) followed by autologous bone marrow or peripheral bloo d stem cell transplantation. Results: Actuarial survival at five years was 51%, and failure-free survival was 40%. Failure-free survival at five years was 90% for patients who received no conventional-dose salv age chemotherapy prior to CBV. Failure-free survival of patients treat ed initially with a four-drug regimen was not significantly different than patients treated with seven/eight-drug regimens. Conclusion: Thes e results appear to be better than those reported for conventional-dos e salvage chemotherapy. High-dose therapy followed by autologous bone marrow or peripheral blood stem cell transplantation should be conside red for any patient with relapsed Hodgkin's disease, regardless of the length of initial remission, or type of initial chemotherapy. Certain patients, especially those with minimal disease, may benefit by proce eding directly to transplantation after relapse, without first receivi ng conventional-dose salvage chemotherapy.