Regimen-related toxicity and non-relapse mortality with high-dose cyclophosphamide, carmustine (BCNU) and etoposide (VP16-213) (CBV) and CBV plus cisplatin (CBVP) followed by autologous stem cell transplantation in patients with Hodgkin's disease

This analysis compares the regimen-related toxicity (RRT) and overall non-r elapse mortality (NRM) in Hodgkin's disease patients conditioned with eithe r CBV (cyclophosphamide, BCNU (carmustine), and VP16-213 (etoposide)) (26 p atients) or CBVP (CBV + cisplatin) (68 patients) followed by autologous ste m cell transplantation (ASCT), CBVP included a continuous infusion rather t han intermittent doses of etoposide, a lower BCNU dose and the addition of cisplatin, RRT and NRM were determined for each regimen and compared; risk factors for each were examined by multivariate analysis. Grade IV (fatal) R RT occurred in five patients (pulmonary in two, cardiac in two, and central nervous system in one). Eighteen patients experienced grade II-III pulmona ry RRT, consistent with BCNU damage in 15, Prior nitrosourea exposure was t he main risk factor for pulmonary RRT, Grade II mucosal and hepatic RRT occ urred less often after CBVP vs CBV (P = 0.031 and 0.0003, respectively), In addition, three other early and eight late non-relapse deaths were seen. M edian follow-up of the entire group is 5.1 (range 2.8-10.2) years. The prob ability of overall NRM was 26% (95% confidence interval (CI) 13-50%) with C BV vs 23% (95% CI 12-41%) with CBVP (P = 0.40), The progression-free surviv al and relapse rates were similar. Although the rates of fatal RRT, pulmona ry RRT and overall NRM were similar with CBV or CBVP, CBVP produced less mu cosal and liver RRT with a comparable antitumor effect. As many autografted patients are cured, future efforts should include measures to decrease NRM .