Long-term follow-up in patients treated with Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin's disease

Several studies have focused on investigation of the optimal salvage regime n to induce maximum response before autologous stem cell transplantation (A SCT) in patients with relapsed or refractory Hodgkin's disease (HD). Howeve r, in most of these studies, the follow-up is relatively short, In the pres ent study, we report on long-term results of 55 consecutive patients with H D who received Mini-BEAM [BCNU (carmustine), etoposide, cytarabine, melphal an] as salvage therapy before ASCT. Eleven patients were refractory to fron t-line therapy, 17 were partial responders, and 27 patients had relapsed fr om HD. Twenty-eight patients achieved complete response, and 18 achieved pa rtial response with a median of two cycles of Mini-BEAM, giving a total res ponse rate of 84%, Significant factors predicting poor response (P < 0.05) were: initial treatment with MOPP (mechloroethamine, oncovin, procarbazine, prednisolone), <greater than or equal to>two previous chemotherapy regimen s and three disease characteristics at Mini-BEAM treatment: presence of B s ymptoms, extranodal involvement or low serum albumin, However, only the las t two factors retained independent influence on multivariate analysis. In t otal, 45/55 patients have been transplanted. Median follow-up after Mini-BE AM administration for living patients is 68 months. At the time of reportin g, 31 out of 55 patients (56.4%) are still alive, 21 patients (38%) have re lapsed, three (5.4%) have developed secondary neoplasias, and five have die d of other complications not related to disease progression. The actuarial 7-year overall survival (OS) was 52%, the progression-free survival (PFS) 5 4% and the event-free survival (EFS) 36%. The response to Mini-BEAM was the most important prognostic factor for predicting the longterm probability o f surviving the disease: none of the eight patients who did not respond to Mini-BEAM were alive at 3 years. On multivariate analysis, response to Mini -BEAM and extranodal involvement before Mini-BEAM had a significant influen ce on OS, Our results show the safety and efficacy of Mini-BEAM before ASCT for refractory or relapsed HD patients.