MiCMA: An alternative treatment for refractory or recurrent Hodgkin's disease

Background: We determined the response rate to MiCMA (mitoxantrone, carbopl atinum, methylprednisolone and aracytin) in a group of 29 patients with Hod gkin's disease (HD) and poor prognostic factors either resistant to first l ine or relapsing after conventional chemotherapy and subsequently evaluated the role of autologous stem-cell transplantation (ASCT) in these patients after MiCMA. Patients and methods: The treatment was intended as a brief tumor debulking program before ASCT. Twenty-nine patients with primary refractory HD or re lapsed HD were submitted to two courses of MiCMA (mitoxantrone 10 mg/m(2) d ay 1; carboplatinum 100 mg/m(2) days 1-4; aracytin 2 g/m(2) day 5; methylpr ednisolone 500 mg/m(2) days 1-5) and subsequently evaluated for response. T hose with responding or stable disease, received one or two other courses o f MiCMA followed by ASCT. Results: There were 10 complete responses (34% CR), 15 partial responses (5 2% PR) and 4 treatment failures with disease progression (14% PD). In total there were 25 evaluable responses out of 29 patients (86% CR + PR). Myelos uppression was the main toxicity of this treatment. At this time 20 patient s (69%) are alive with a median follow-up of 26.5 months (7-100), 13 patien ts in CR (45%), 8 patients died, 7 of them from disease progression and one due to multi-organ failure, one patient is lost to follow-up. All but one of the patients who achieved CR after MiCMA are alive. Only the number of e xtranodal sites was found to predict a poor response to MiCMA. Conclusions: A short pre-transplantation treatment with MiCMA is an effecti ve tumor debulking approach in patients with refractory or relapsed HD.