Double high-dose therapy for Hodgkin's disease with dose-intensive cyclophosphamide, etoposide, and cisplatin (DICEP) prior to high-dose melphalan and autologous stem cell transplantation

We previously reported a 50% (95% CI = 33-76%) 5 year event-free survival ( EFS) rate for 23 patients with Hodgkin's disease (HD) who received salvage therapy with single agent high-dose melphalan (HDM) and autologous stem cel l transplantation (ASCT), Predictors of poor outcome included bulky disease and initial remission <1 year. Since 1995, similar poor prognosis patients have been treated with double high-dose therapy consisting of dose-intensi ve cyclophosphamide 5.25 g/m(2), etoposide 1.05 g/m(2), cisplatin 105 mg/m( 2) (DICEP) for tumor cytoreduction and stem cell mobilization followed by H DM/ASCT. The purpose of the present study is to determine if the use of DIC EP is associated with improved event-free (EFS) and overall survival (OAS) for patients treated with HDM/ASCT, From February 1981 to June 1999, 46 con secutive patients received HDM/SCT for relapsed (n = 35) or refractory (n = 11) HD, DICEP re-induction and blood stem cell mobilization was used for 2 1 patients. Factors considered for univariate and multivariate analyses inc luded age at transplant, number of failed chemotherapy regimens, prior radi otherapy, length of initial remission, relapsed or refractory disease statu s, extranodal relapse, B symptoms at relapse, bulk, post-ASCT radiotherapy, and DICEP re-induction therapy, Cox proportional hazards models were const ructed for both event and death, DICEP and HDM were well tolerated with no early treatment-related mortality or toxicity requiring life-sustaining mea sures. For all 46 patients, the projected 5 year EFS was 52% (9% CI = 38-72 %) and OAS was 57% (95% CI = 40-82). Factors independently associated with relapse in multivariate analysis included bulk >5 cm (RR = 6.38, P = 0.002) , prior radiotherapy (RR = 3.59, P = 0.027), and not using DICEP (RR = 5.29 , P = 0.005), Factors independently associated with death included bulk >5 cm (RR = 5.13, P = 0.009), greater than or equal to 3 prior chemotherapy re gimens (RR = 4.72, P = 0.019), and not using DICEP (RR = 7.49, P = 0.015), This study demonstrates that DICEP re-induction prior to HDM/ASCT is feasib le. The preliminary data are sufficiently encouraging to warrant a multicen ter phase II or a phase III trial evaluating DICEP followed by HDM/ASCT as salvage therapy for HD.