Salvage chemotherapy with mini-BEAM for relapsed or refractory Hodgkin's disease prior to autologous peripheral brood stem cell transplantation

Background and Objectives. High-dose chemotherapy and autologous bone marro w transplantation (ABMT) has become the standard approach for most patients with relapsed or refractory Hodgkin's disease. Disease status at transplan t has been correlated with outcome following ABMT. In light of this, we emp loy mini-BEAM (BCNU, etoposide, cytarabine and melphalan) salvage therapy i n order to achieve a state of minimal residual disease prior to transplanta tion. Design and Methods. From February 1992 to June 1998 twenty-four patients re ceiving mini-BEAM therapy for resistance or relapse of their Hodgkin's dise ase were included. Four patients had obtained no response with initial chem otherapy (refractory), eight had obtained an incomplete response, seven wer e in first relapse and five in second or subsequent relapse. Fifteen patien ts received mini-BEAM as first salvage chemotherapy regimen. The remaining nine patients had previously been exposed to a median of one salvage regime n. Patients received a median of three cycles of mini-BEAM. Results. Sixteen patients achieved complete remission and four partial remi ssion, yielding an overall response rate of 83%. No significant differences in response were observed between patients who received mini-BEAM as initi al salvage therapy and those who had received a prior salvage regimen. Eigh teen out of the twenty responding patients went on to intensive therapy and peripheral blood stem cell transplantation. With a median follow-up of 52 months, the cumulative probability of 7-year overall survival is 71% for th e responders and that of the 6-year disease-free survival is 42%. No treatm ent-related deaths were observed. Interpretation and Conclusions. Mini-BEAM is an effective salvage regimen w ith moderate toxicity that may be useful for cytoreduction prior to stem ce ll procedures. (C) 1999, Ferrata Storti Foundation.