EARLY INTENSIVE THERAPY WITH AUTOLOGOUS STEM-CELL TRANSPLANTATION IN ADVANCED HODGKINS-DISEASE - RETROSPECTIVE ANALYSIS OF 158 CASES FROM THE FRENCH REGISTRY

This retrospective study was undertaken to evaluate cure rates, toxici ty and late effects of early intensive therapy followed by autologous stem cell transplantation (ASCT) in patients with advanced Hodgkin's d isease (HD). One hundred and fifty-eight cases of ASCT registered in t he French database (SFGM) were retrospectively analyzed. Disease statu s at the time of ASCT was first partial response (PR) in 85, first com plete remission (CR1) in 45 or primary refractory in 28 cases. The med ian time interval between diagnosis and ASCT was 7 months (range 4-13) . At the time of analysis in December 1995, 121/158 patients (76.6%) w ere alive, including 111 (70.2%) in continuous CR with a median follow -up for surviving patients of 46 months (range 8-123). Peri-ASCT toxic death rate was 3%, and the actuarial risk of new malignancies was 4.9 % at 5 years. The cumulative probability of 5-year overall survival (O S) was 75.2% for the entire group of patients, 80.6% for the chemosens itive ones, and 33.9% for the primary refractory (chemosensitive vs re fractory, P < 0.0001). The cumulative probability of 5-year event-free survival (EFS) was 66.1% for the entire group of patients, 73.7% for the chemosensitive ones, and 26.1% for the primary refractory (chemose nsitive vs refractory, P < 0.0001). The only significant prognostic fa ctor for both OS and EFS was disease status at the time of ASCT. Early ASCT in advanced HD is feasible, with a low risk of toxicity and with out a higher rate of late effects compared with conventional treatment . Results achieved in chemosensitive patients at the time of transplan tation lay the basis of future prospective randomized trials comparing ACST as front-line treatment to conventional treatment in high-risk c ases.