HIGH-DOSE SEQUENTIAL CHEMORADIOTHERAPY WITH PERIPHERAL-BLOOD PROGENITOR-CELL SUPPORT FOR RELAPSED OR REFRACTORY HODGKINS-DISEASE - A 6-YEARUPDATE

Background: Very few studies using high-dose therapy and autologous bo ne marrow transplantation have a long (i.e., >3 years) follow-up. We r eport here the 6-year update of a study employing high-dose sequential chemo-radiotherapy in 25 patients with poor-risk Hodgkin's disease. P atients and methods: All patients were either refractory (7 patients) or partial responders (9 patients) or early relapses (9 patients) foll owing induction chemotherapy consisting of MOPP/ABVD in 20 patients an d MOPP/ABVD followed by salvage CEP for the remaining 5 patients. The high-dose chemo-radiotherapy regimen employed consisted in the rapid s equential administration of high-doses of cyclophosphamide, methotrexa te, etoposide and total body irradiation plus melphalan. Results: As c ompared to 4-year results, the 6-year probabilities of relapse-free su rvival, freedom from progression and overall survival were almost supe rimposable. In fact, during the two additional years elapsed since pri or survey, only one event occurred (fatal cerebral hemorrhage) that wa s unrelated to Hodgkin's disease. In particular, the proportion of pat ients remaining event-free was 78% for those with short initial comple te response and 31% for patients who had failed initial MOPP/ABVD. Acc ording to previous experience, both groups have a very low or no chanc e of long-term event-free survival when treated with standard-dose sal vage chemotherapy. Conclusions: The very favorable long-term results o f the high-dose sequential regimen together with its excellent tolerab ility and lack of early or late fatal toxicities, will assist clinicia ns in defining optimal timing for high-dose therapy in the management of Hodgkin's disease. According to a revised cost/benefit analysis, it would appear that, at present, the best timing of high-dose sequentia l therapy in patients failing MOPP/ABVD is at first early relapse.