High dose chemotherapy with G-CSF in refractory Hodgkin's disease

This study analyzed the long-term results in patients with Hodgkin's diseas e (HD) who were resistant or refractory to conventional chemotherapy and wh o were treated with intensive, non- myeloablative chemotherapy with granulo cyte colony-stimulating factor (G-CSF) as hematological support. The study population included 86 patients who were treated with combination chemother apy with high doses: BCNU, 300 mg/m(2) on day 1, vincristine 1.4 mg/m(2), a nd bleomycin 10 mg/m(2) on days 1, 7, 14 and 21; etoposide 500 mg/m(2), iv, on days 14 and 15; and ifosfamide 4 g/m(2) and epirubicin 180 mg/m(2) on d ay 29. G-CSF 5ug/kg/day, was used to ameliorate severe myelosuppression on days 3 to 13, 16 and 26 and 29 to 38. If a complete response was observed, two cycles of IOPP (ifosfamide 1.5 g/m(2), iv, on days 1 and 8; vincristine 1.4 mg/m(2), iv on days 1 and 8; prednisone 60 mg/m(2), po, daily, days 1 to 14 and procarbazine 100 ng/m(2), po, daily, days 1 to 14 vere given as c onsolidation therapy. At 8-years, the overall survival rate vas 58 % (50 ou t of 86 patients) being 38 and 76 % in patients whose initial complete resp onse was shorter or longer that 12 months, respectively or in 44 % of induc tion failures. Hematological toxicity grade III or IV was observed in all c ycles. However hematological recovery was already evident (median on day 13 ). Only transitory delay in continuing therapy was observed (median 3.9 day s). Twenty-two patients developed infection-related granulocytopenia but no therapy related deaths were observed. G-CSF was well tolerated. This study indicates that the hematopoetic growth factor, G-CSF, was sufficient to ac t as hematological support in patients who received intensive, but non-myel oablative chemotherapy. In our opinion intensive chemotherapy without autol ogous transplant procedures can be considered in patients with refractory H odgkin's disease because complete response rate and overall survival times are similar to more aggressive but more toxic regimens.