Feasibility of tandem autologous stem-cell transplantation (ASCT) in induction failure or very unfavorable (UF) relapse from Hodgkin's disease (HD)

Background: Despite high-dose therapy and ASCT some patients with aggressiv e HD fail to achieve long-term survival. Patients and methods: Forty-three patients with induction failure (n = 19) or very unfavorable (UF) relapse (n = 24) from HD were included in a multic entric study of tandem ASCT. They planned to receive two courses of IVA(75) with GCSF and blood stem-cell collection. ASCT1 was conditionned with CBV + mitoxantrone (30 mg/m(2)) and ASCT2 (cytarabine 6 g/m(2), melphalan 140 m g/m(2) and total body irradiation at 12 Gy or busulfan 16 (n = 4) than 12 m g/kg). After salvage therapy, response > 50% was observed in 63% of the pat ients (six patients were included for refractory relapse). Four patients ha d no ASCT for disease progression; seven patients had only ASCT1 (disease p rogression, n = 3) and thirty-two patients (74%) received the two ASCT. Results: Hematologic recovery was normal after ASCT1 but delayed platelet r ecovery was observed after ASCT2 with busulfan in the conditioning regimen. Two VOD with one fatal occured with busulfan at 16 mg/kg and one hemorragi c cystis, no further grade 4 toxicity was observed with the reduced doses o f busulfan (12 mg/kg). After ASCT2, 83% of these UF patients were in remiss ion and 20% relapsed within the first year. On an intent-to-treat analysis, 22 of 43 patients are in continuous CR (including 8 patients with inductio n failure). For the whole population (n = 43) and for patients receiving th e two ASCT (n = 32), the two-year survival from the date of progression wer e respectively at 65% and at 74%. Conclusion: double ASCT is feasible in very UF relapse from HD and may lead to some prolonged remission.