HIGH-DOSE CHEMOTHERAPY WITH OR WITHOUT TOTAL-BODY IRRADIATION FOLLOWED BY AUTOLOGOUS BONE-MARROW AND OR PERIPHERAL-BLOOD STEM-CELL TRANSPLANTATION FOR PATIENTS WITH RELAPSED AND REFRACTORY HODGKINS-DISEASE - RESULTS IN 85 PATIENTS WITH ANALYSIS OF PROGNOSTIC FACTORS/

Eighty-five consecutive patients with relapsed or refractory Hodgkin's disease (HD) underwent high-dose chemotherapy or chemo/radiotherapy f ollowed by autologous bone marrow (ABMT) and/or peripheral blood stem cell (PBSC) transplantation. Two preparative regimens were used. Twent y-two patients (26%) without prior radiation received fractionated tot al body irradiation (FTBI) 1,200 Gy in combination with high-dose etop oside (VP-16) 60 mg/kg and cyclophosphamide (CTX) 100 mg/kg. Sixty-thr ee patients (74%) with prior radiotherapy received carmustine (BCNU) 4 50 mg/m(2) instead of FTBI. The median age was 32 years (range, 16 to 56). The median number of prior chemotherapy regimens was three (range , 1 to 7). Forty-three patients (51%) received transplants in first re lapse or second complete remission (CR), whereas 33 (39%) received tra nsplants after second or subsequent relapse. All relapsed patients, ex cept one, received conventional salvage chemotherapy and/or radiothera py in an attempt to reduce tumor bulk before transplant. At the time o f analysis in April 1994, fiftyseven patients (67%) are alive, includi ng 44 (52%) in continuous CR, with a median follow-up for the survivin g patients of 28 months (range, 7 to 66). Thirty patients (35%) relaps ed at, a-median of 9 months (range; 1 to 43). Eleven patients (13%) di ed of transplant-related complications including: veno-occlusive disea se of the liver (VOD) in five, acute and late interstitial pneumonitis in three, graft failure in one, cerebral hemorrhage in one, and thera py-induced myelodysplasia (MDS)/acute leukemia in one patient. At a me dian follow-up of 25 months (range, 0.6 to 66), the cumulative probabi lity of 2-year overall and disease-free survival (DFS) of all 85 patie nts is 75% (95% confidence interval [CI] 64% to 84%) and 58% (95% CI 4 7% to 69%), respectively. Three independent prognostic variables were identified by univariate analysis: number of prior chemotherapy regime ns, prior radiotherapy, and extranodal disease at ABMT. Multivariate s tepwise Cox regression identified the number of prior chemotherapy reg imens as the only significant prognostic factor predicting for both re lapse and DFS. There were no significant differences in the outcome of the treatment between the two preparative regimens. Our results confi rm that high-dose therapy and ABMT is an effective therapy for patient s with relapsed or refractory HD. Earlier transplantation is recommend ed before the development of drug resistance and end organ damage that results from repeated attempts of salvage therapy. (C) 1995 by The Am erican Society of Hematology.