RESULTS OF CAV REGIMEN (CCNU, MELPHALAN, AND VP-16) AS 3RD-LINE SALVAGE THERAPY FOR HODGKINS-DISEASE

Background& A prospective study was conducted to assess the efficacy a nd toxicity of a salvage regimen consisting of CCNU, Melphalan, and VP -16 (CAV) given at 28-day intervals in patients with Hodgkin's disease (HD) relapsing after primary therapy or refractory to the alternating MOPP/ABVD regimen. Patients and methods: This study included 58 patie nts (median age: 34 years), with resistant or relapsing HD. Primary th erapy had consisted of alternating MOPP/ABVD (81%) or MOPP alone (19%) ; 3 8% of patients were relapsing from prior complete remission (CR) w hile 62% had resistant disease. Extranodal disease was present in 55% and B-symptoms in 72% of patients; one-fifth had bulky disease and/or bone marrow involvement. The CAV was used as first salvage in half of the patients. Results: Complete remission was obtained in 17 patients (29%); unfavorable factors for CR in univariate analysis were the pres ence of bulky disease and the failure to achieve CR with prior therapy . Nine patients (53% of remitters) have subsequently relapsed with a 1 0-month median duration of CR. The 3-year overall survival after CAV w as 25% with an 18-month median survival; significant differences in su rvival were found according to the extent of disease, the presence of B-symptoms and the HD status (prior sensitive or resistant disease, fi rst or subsequent relapse). Seven patients are longterm remitters (12% ), and one of them has been given highdose chemotherapy and autologous bone marrow transplantation at relapse after CAV. The CAV toxicity wa s mostly hematological; severe pancytopenia occurred in six cases with two cases of fatal infections and one of fatal hemorrhage. Conclusion : CAV therapy was moderately effective as third-line salvage in patien ts with HD resistant to alternating MOPP/ABVD or previously given two different regimens for relapse; the toxicity was mostly hematological and supportive therapy was needed in one-third of the patients.