THE MINE REGIMEN AS INTENSIVE SALVAGE CHEMOTHERAPY FOR RELAPSED AND REFRACTORY HODGKINS-DISEASE

Background: Relapsed or refractory Hodgkin's disease (HD) patients wer e treated with an intensive salvage regimen (MINE) prior to high-dose therapy (HDT) with hematopoietic stem cell support. Patients and metho ds: One hundred HD patients who either failed to respond to a front-li ne chemotherapy regimen (induction failure, n = 41) or relapsed (untre ated relapse, n = 54; resistant relapse, n = 5) were treated with the MINE regimen. Each course of MINE comprised mitoguazone 500 mg/ m(2) o n days 1 and 5, ifosfamide 1500 mg/m(2)/d from day 1 to day 5, vinorel bine (Navelbine(R)) 15 mg/m(2) on days 1 and 5, and etoposide 150 mg/m (2)/d from day 1 to day 3. At least two courses were given at 4-week i ntervals. Then, 72 patients received HDT followed by hematopoietic ste m cell support. Results: After MINE salvage, 34 patients achieved a co mplete response (CR) and 39 a partial response, yielding an overall re sponse rate of 75%. Patients with untreated relapse had a 92.5% respon se rate and those with resistant relapse or induction failure a 53% re sponse rate. A total of 58 patients reached a CR at the end of all tre atments; 12 of them relapsed. Sixty-six patients were alive with a med ian follow-up of 26 months, including 46 patients in CR. The 2-year su rvival rate for the entire group was 59%. By univariate analysis, pati ents with an interval between their last treatment and salvage longer than 12 months, untreated relapse, or good performance status at salva ge are shown to have longer survivals. The main toxic effects were neu tropenia, thrombocytopenia, and infectious episodes. Three patients di ed of MINE-related complications and three after HDT. Conclusion: Give n early in the course of progressive HD, the MINE regimen reduced tumo r burden in a high proportion of patients with relapsed or refractory disease. Responding patients further intensified with HDT have a bette r outcome than those who have not responded to salvage treatment.