High-dose therapy and autologous stem-cell transplantation for adult patients with Hodgkin's disease who do not enter remission after induction chemotherapy: Results in 175 patients reported to the European Group for Blood and Marrow Transplantation

Purpose: To investigate the results of high-dose therapy and autologous ste m-cell transplantation (ASCT) in adults with Hodgkin's disease who do not e nter remission after induction therapy, to determine overall survival (OS) and progression free survival (PFS), and to identify prognostic factors. Patients and Methods: A retrospective analysis of 175 patients reported to the European Group for Blood and Marrow Transplantation between November 19 79 and October 1995. One hundred were male and 75 were female, with a media n age of 26.5 years. Responses to first-line therapy were defined as progre ssive disease (PD) in 88 and stable/minimally responsive disease (SD/MR) in 87. Seventy-five patients received ASCT after failure of one induction reg imen. Second-line therapy was given to the remaining 100 patients. Response to second-line therapy was PD in 34 and SD/MR in 66. OS and PFS rates were determined, and prognostic factors were investigated using univariate and multivariate analyses. Results: Responses to high-dose therapy and ASCT were complete response (30 %), partial response (28%), no response (14%), PD (14%), and toxic death (1 4%). Actuarial 5-year OS and PFS rates were 36% and 32%, respectively. In u nivariate analysis for PFS and OS, adverse factors were use of a second-lin e chemotherapy regimen and interval of more than 18 months between diagnosi s and ASCT. In multivariate analysis, the interval between diagnosis and AS CT maintained prognostic significance for OS. Response to the chemotherapy regimen given immediately before ASCT had no predictive value. Conclusion: High-dose therapy and ASCT is an effective treatment strategy f or patients with Hodgkin's disease for whom induction chemotherapy fails. O utcome was equivalent for those with obvious PD or SD/MR in response to the regimen given immediately before high-dose therapy. prospective randomized studies are required ta compare this approach with conventional-dose salva ge therapy. (C) 1999 by American Society of Clinical Oncology.