P. Brice et al., Feasibility of tandem autologous stem-cell transplantation (ASCT) in induction failure or very unfavorable (UF) relapse from Hodgkin's disease (HD), ANN ONCOL, 10(12), 1999, pp. 1485-1488
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.