HIGH-DOSE THERAPY AND AUTOLOGOUS HEMATOPOIETIC PROGENITOR-CELL TRANSPLANTATION FOR RECURRENT OR REFRACTORY HODGKINS-DISEASE - ANALYSIS OF THE STANFORD-UNIVERSITY RESULTS AND PROGNOSTIC INDEXES

One hundred nineteen patients with relapsed or refractory Hodgkin's di sease (HD) received high-dose therapy followed by autologous hematopoi etic progenitor cell transplantation. Three preparatory regimens, sele cted on the basis of prior therapy and pulmonary status, were employed . Twenty-six patients without a history of prior chest or pelvic irrad iation were treated with fractionated total body irradiation, etoposid e (VP) 60 mg/kg and cyclophosphamide (Cy) 100 mg/kg. Seventy-four pati ents received BCNU 15 mg/kg with identical doses of VP and Cy. A group of 19 patients with a limited diffusing capacity or history of pneumo nitis received a novel high-dose regimen consisting of CCNU 15 mg/kg, VP 60 mg/kg and Cy 100 mg/kg. Twenty-nine patients (24%) had failed in duction therapy and 35 (29%) had progressive HD within 1 year of initi al chemotherapy. At 4 years actuarial survival was 52%, event-free sur vival was 48% and freedom from progression (FFP) was 62%. No significa nt differences were seen in survival data with the three preparatory r egimens. Six patients died within 100 days of transplantation and 5 di ed at a later date of transplant-related complications. Secondary mali gnancies have developed in 6 patients, including myelodysplasia/leukem ia in four patients and solid tumors in two patients. Regression analy sis identified systemic symptoms at relapse, disseminated pulmonary or bone marrow disease at relapse and more than minimal disease at the t ime of transplantation as significant prognostic factors for overall a nd event-free survival and FFP. Patients with none of these factors en joyed an 85% FFP at 4 years compared with 41% for patients with one or more unfavorable prognostic factors (P = .0001). Our results confirm the efficacy of high-dose therapy and autografting in recurrent or ref ractory HD. Although longer follow-up is necessary to address ultimate cure rates and toxicity, our data indicate that a desire to reduce la te effects should drive future research efforts in favorable patients whereas new initiatives are needed for those with less favorable progn oses. (C) 1997 by the American Society of Hematology.