FAVORABLE OUTCOME OF PATIENTS WITH RELAPSED OR REFRACTORY HODGKINS-DISEASE TREATED WITH HIGH-DOSE CHEMOTHERAPY AND STEM-CELL RESCUE AT THE TIME OF MAXIMAL RESPONSE TO CONVENTIONAL SALVAGE THERAPY (DEXA-BEAM)

Background: Disease status before high-dose chemotherapy with autologo us bone marrow transplantation (ABMT) or peripheral blood stem cell tr ansplantation (PBSCT) is an important predictor of transplanlation-rel ated toxicity and event-free survival (EFS) for patients with relapsed or refractory Hodgkin's disease (IID). We performed a phase II study in patients with relapsed or refractory HD to evaluate the feasibility of four cycles of Dexa-BEAM followed bq high-dose chemotherapy with A BMT or PBSCT. Patients and methods: Twenty-six patients (median age 30 , range 20-40 years) were treated with 2-4 courses of dexamethasone, c armustine, etoposide, cytarabine and melphalan (Dexa-BEAM) as salvage chemotherapy in order to attain maximal response. Patients achieving c omplete response (CR) or partial response (PR) received high-dose chem otherapy with ABMT or PBSCT. The conditioning regimen used alas CVB (c yclophosphamide, carmustine, etoposide). Results: Eighteen patients re sponded to Dexa-BEAM, resulting in a response rate of 69%. At the time of transplant 16 patients were in C'R two patients in PR. At present 14 patients transplanted are in continous CR (median follow-up 40 mont hs, range 14-60 months). Two patients with PR after four courses of De xa-BEAM relapsed and died three months posttransplantation. Two patien ts with CR at the time of transplant relapsed after nine and 13 months respectively. Eight patients had rapid progressive disease after 2-4 cycles of Dexa-BEAM. One patient with progressive disease died in gram -negative sepsis after four cycles of Dexa-BEAM. There was no transpla nlation-related: death. Conclusions. These data suggests the use of hi gh-dose chemotherapy followed by stem cell transplantation at the time of maximal response.