EARLY INTENSIVE THERAPY WITH AUTOLOGOUS STEM-CELL TRANSPLANTATION IN HIGH-RISK HODGKINS-DISEASE - LONG-TERM FOLLOW-UP IN 35 CASES

Thirty-five adult patients with high-risk HD (IID) defined by (1) Am A rbor stage IV or bulky nodal disease (tumor/thorax ratio > 0.45) and ( 2) no or partial response (PR) (< 75%) to the initial 3 courses of ABV D, received an early intensive therapy with autologous stem cell trans plantation (ASCT). Thirty patients were considered as partial responde rs and 5 as refractory to initial chemotherapy. Conditioning regimen c onsisted of chemotherapy alone (CBV in II patients before 1993, BEAM i n 13 patients since 1993) followed by adjuvant radiotherapy: 40 Gy) on the initial sites of bulky disease, or 12 Gy total body irradiation p lus 120 mg/kg cyclophosphamide in 11 patients with disseminated extra- nodal disease. All 30 patients in PR at the time of ASCT experienced p rolonged complete remission (CR). One patient died in CR from an acute myocardial infarction 48 months after ASCT. Four out of the 5 patient s with refractory disease at the time of ASCT experienced rapid progre ssion of HD leading to death in 3 cases. After 6 years of CR post-ASCT , the last refractory patient died of myelodysplastic syndrome diagnos ed 2 years after intensive therapy. With a median follow-up for surviv ing patients of 51 months (range: 11-111), the cumulative probability of 8-year overall survival is 75.6% for the entire group of patients, 94.1% for the chemosensitive ones, and 0% for the primary refractory ( P < .0001). The cumulative probability of 8-year event-free survival i s 79.9% for the entire group of patients, 94.1% for the chemosensitive ones, and 0% for the primary refractory (P < .0001). We conclude that early intensive therapy with ASCT is feasible in patients with high-r isk HD and induces a high cure rate in chemosensitive patients. In pri mary refractory patients, new therapeutic approaches are warranted.