ASHAP: A regimen for cytoreduction of refractory or recurrent Hodgkin's disease

Patients with Hodgkin's disease, which is either refractory or recurs after frontline chemotherapy with MOPP (mechlorethamine, vincristine, procarbazi ne, and prednisone), ABVD (doxorubicin, bleomycin, vinblastine, and dacarba zine), or both regimens, generally have a poor prognosis. High-dose chemoth erapy with autologous marrow or stem cell rescue (ABMT) is now a widely use d salvage strategy in these patients. In this study, our objective was to d etermine the response rate to ASHAP (Adriamycin = doxorubicin, Solumedrol = methylprednisolone, High-dose Ara-C = cytosine arabinoside, and Platinum = cisplatinum), in a group of patients with Hodgkin's disease with such poor risk characteristics. The treatment was intended as a brief tumor reducing program before ABMT. Fifty-six patients with diagnosed relapsed or primary refractory Hodgkin's disease underwent this treatment. The program consist ed of the administration of two cycles of ASHAP chemotherapy (doxorubicin 1 0 mg/m(2)/d intravenous (IV) continuous infusion (CI) over 24 hours, days 1 to 4; methylprednisolone 500 mg/d IV over 15 minutes daily for 5 days; cis platinum 25 mg/m(2)/d IV CI over 24 hours, days 1 to 4; cytosine arabinosid e 1.5 g/m(2)/d IV over 2 hours on day 5). After two courses of ASHAP the pa tients were evaluated for response, including a gallium scan test. Patients with progressive disease were taken off the study. Those with responding o r stable disease received ct third course of ASHAP, followed by consolidati ve treatment with ABMT. There were 19 complete responses (34% CR), 20 parti al responses (36% PR), and 17 treatment failures, including 8 with minor re sponses and 9 with disease progression. Thus, in total there were 39 respon ses out of 56 patients (CR + PR = 70%). Myelosuppression was the main toxic ity. There were no deaths due to toxicity. At this time, 23 patients are al ive. There were 31 deaths due to disease progression and 2 due to other cau ses. The initial response to ASHAP before subsequent ABMT consolidation tre atment correlated with survival. All 17 patients in whom ASHAP failed to ac hieve a response have died. The presence of B symptoms at relapse, and a du ration of response to the last regimen of less than or equal to 6 months, p redicted a poor response to ASHAP A short program of treatment with ASHAP i s an effective tumor debulking approach in patients previously treated with both or either ABVD and MOPP, before ABMT. (C) 1999 by The American Societ y of Hematology.