SINGLE-AGENT HIGH-DOSE MELPHALAN SALVAGE THERAPY FOR HODGKINS-DISEASE- COST, SAFETY, AND LONG-TERM EFFICACY

Background. Few data are available on the cost, safety, and long-term efficacy of single-agent high-dose melphalan (HDM) followed by autolog ous bone marrow (ABMT) or blood stem cell (ABSCT) transplantation in t he salvage therapy of Hodgkin's disease (HD). Patients and methods. Fr om February 1981 to September 1996, 23 patients with relapsed (n = 15) or refractory (n = 8) HD received salvage therapy with HDM 140-200 mg /m(2) followed by non-cryopreserved ABMT (n = 18) or cryopreserved ABS CT (n = 5). The cost of HDM/ABSCT in 1996, from initial consultation u ntil transfer back to referring physician was determined and compared to the estimated costs of two multi-agent regimens commonly used for H D. Results. HDM was well tolerated with no early transplant-related mo rtality. The five-year overall and progression-free survival rates wer e 52% and 50%, respectively. The average total cost in Canadian funds of HDM/ABSCT in 1996 was $34,400/patient. This cost was estimated to b e $4,700-6,800 cheaper per patient than the multi-agent high-dose regi mens. Conclusion: These data suggest that HDM is safe, feasible, activ e, and reasonably inexpensive salvage therapy for patients with relaps ed/refractory HD.