Summary:We evaluated prognostic factors and treatment outcome of patients with relapsed/refractory Hodgkin's disease (HD) receiving autologous stem cell transplantation (ASCT). In total, 92 patients received total body irradiation, cyclophosphamide and etoposide (TBI/CY/ E) (n ¼ 42) or busulfan, melphalan and thiotepa (Bu/Mel/ T) (n ¼ 50) supported with ASCT. A total of 33 (66%) patients receiving the Bu/Mel/T regimen had a prior history of dose-limiting irradiation. Mucositis, hepatic and pulmonary toxicities were the main causes of morbidity and mortality, irrespective of the conditioning regimen. The transplant-related mortality was 15%. With a median follow-up of 6 years (range 2.5-11), the cumulative probabilities of survival, event-free survival (EFS) and relapse at 6 years were 55, 51 and 32%. The 6-year Kaplan-Meier (KM) probabilities of EFS for patients with less advanced disease (patients in first chemotherapy-responsive relapse or second remission (n ¼ 42)) and more advanced disease (all other patients (n ¼ 50)) were 60 and 44%. No differences in toxicities and efficacy between the conditioning regimens were found. ASCT is an effective treatment for patients with refractory/relapsed HD. Female patients and patients with less advanced disease at transplant had a better outcome. Patients with prior irradiation benefited from the Bu/Mel/T regimen. Bone Marrow Transplantation (2003) 32, 279-285. doi:10.1038/sj.bmt.1704110 Keywords: Hodgkin's disease; autologous; stemcell transplant; total body irradiation; high dose chemotherapy Hodgkin's disease (HD) is a highly chemosensitive malignancy with approximately 50-60% of patients being cured with conventional chemotherapy/radiation therapy. Patients with stage III or IV disease who fail to attain a complete remission or relapse after induction chemotherapy, however, are rarely cured from standard salvage therapies. 1 High-dose chemotherapy with or without radiation therapy supported with autologous stem cell transplantation (HDC/ASCT) is potentially curative for this subset of patients. 2-21 Total body irradiation (TBI) in combination with high-dose cyclophosphamide (CY) (TBI/ CY) 3,4 and etoposide (TBI/CY/E), 5,6 , and the combination of CY, carmustine and etoposide (CVB), 5,6,9,10,12-16 carmustine, etoposide, cytosine arabinoside with either melphalan (BEAM) 18,19 or cyclophosphamide (BEAC) 20 constitute the most common high-dose regimens evaluated. The superiority of a specific regimen, however, has not been demonstrated. 3,5,6 In 1993, the Fred Hutchinson Cancer Research Center (FHCRC) reported the outcomes of 127 patients with relapsed/refractory HD treated with chemotherapy-only (n ¼ 66) or TBI-based (n ¼ 61) regimens followed by autologous (n ¼ 68), allogeneic (n ¼ 53) and syngeneic (n ¼ 6) bone marrow (BM) transplantation. 3 The high-dose regimens evaluated were TBI/CY (n ¼ 47), CVB (n ¼ 47), Cy and busulfan (Bu) (n ¼ 18) and others (n ¼ 15). The actuarial 5-year event-free survival (EFS) was 18% for the entire group and 22 and 14% for allogeneic and ...

No abstract

Granulocyte colony-stimulating factor (G-CSF), which is widely used to mobilize peripheral blood stem cells (PBSC) from normal donors, has led to the use of PBSC as a major alternative to bone marrow for patients undergoing allogeneic transplants. Safety issues related to the administration of G-CSF to normal donors, however, are still under study. The short-term effects after G-CSF administration are well known and manageable. G-CSF induces a hypercoagulable state, which may predispose certain donors to thrombotic complications. A dose of 10 microg/kg/d for 5 days has been recommended for routine clinical use, but the optimal dose and schedule for PBSC collection are still being defined. Small studies to date have shown no late effects of G-CSF administration but there is insufficient information regarding any long-term adverse effects or risks. Although the administration of G-CSF to normal donors for PBSC collection appears safe, longer follow-up is required.