Double high-dose therapy with dose-intensive cyclophosphamide, etoposide, cisplatin (DICEP) followed by high-dose melphalan and autologous stem cell transplantation for relapsed/refractory Hodgkin lymphoma

Abstract

The purpose of the present study was to review retrospectively our results of double high-dose therapy with DICEP (dose-intensified cyclophosphamide 5.25 g/m(2), etoposide 1.05 g/m(2), and cisplatin 105 mg/m(2)) re-induction followed by high dose melphalan 200 mg/m(2) (HDM) and autologous stem cell transplantation (ASCT) for 73 consecutive patients with relapsed (n = 43) or refractory (n = 30) classical Hodgkin lymphoma (HL) treated between June 1995 and November 2009. DICEP chemotherapy resulted in successful stem cell mobilization in 71 patients (97%), with a median CD34 (+) cell collection of 15.6 × 10(6)/kg. With a median follow-up of 56 months post-DICEP, the 5-year progression free survival (PFS) and overall survival (OS) rates were 61% [95%CI = 49-72%] and 80% [95%CI = 69-89%], respectively. The 5-year PFS was 65% vs. 30% for DICEP responders vs. nonresponders (logrank p = 0.003) and 89% for International Prognostic Score (IPS) = 0-1, 56% for IPS = 2-3, and 24% for IPS = 4-7 (logrank p < 0.001). Response to DICEP and IPS at relapse were the only two factors that independently predicted PFS and OS in multivariate analyses. Treatment-related mortality was 1%. In conclusion, DICEP-HDM/ASCT is well tolerated double high-dose therapy associated with excellent stem cell mobilization and favorable PFS and OS outcomes for relapsed as well as primary refractory HL.

Hodgkin's lymphoma: Saudi Lymphoma Group's clinical practice guidelines for diagnosis, management and follow-up

“…In most patients with relapsed or refractory HL, the preferred treatment modality comprises platinum-based or brentuximab vedotin-containing regimen followed by high-dose chemotherapy and ASCT (EL-2). [3839404142434445464748] 4.3.3.1 Salvage regimens such as GDP (gemcitabine, dexamethasone, and cisplatin);[49] DICEP (dose-intensive cyclophosphamide, etoposide, cisplatin);[4243] ESHAP (etoposide, methylprednisolone (solumedrol), high-dose cytarabine (ara-C) and cisplatin (platinum chemotherapy);[50] DHAP (dexamethasone, cytarabine, cisplatin);[40] IGEV (ifosfamide, gemcitabine, and vinorelbine);[41] ICE (ifosamide, carboplatin, and etoposide);[51] B-ICE (brentuximab vedotin plus ifosamide, carboplatin, and etoposide;[52] B-ESHAP (brentuximab vedotin plus etoposide, methylprednisolone (solumedrol), high-dose cytarabine (ara-C) and cisplatin (platinum chemotherapy);[53] BeGEV (bendamustine, gemcitabine and vinorelbine) or BvB (Brentuximab vedotin and bendamustine)[5455] have been shown to reduce the disease burden and mobilize stem cells before high-dose chemotherapy and ASCT. However, no comparative trails have shown any salvage approach to be superior than the others (EL-2).4.3.3.2.…”

“…In most patients with relapsed or refractory HL, the preferred treatment modality comprises platinum-based or brentuximab vedotin-containing regimen followed by high-dose chemotherapy and ASCT (EL-2). [3839404142434445464748]…”

Advances in the pathophysiology and treatment of relapsed/refractory Hodgkin&rsquo;s lymphoma with an emphasis on targeted therapies and transplantation strategies

“…The risk is influenced by the presence of disease-related risk factors and, possibly, by the type of the conditioning regimen. 134,160,161 Some investigators have favored more intensive salvage regimens prior to ASCT 135,162 with variable results. However, in the absence of prospective comparative trials, such approaches have not been widely adopted.…”

Relapsed Hodgkin lymphoma in adolescents: focus on current high-dose chemotherapy and autologous stem cell transplant

“…5 Tandem HDCT and ASCT Several investigators have published outcomes of sequential HDCT followed by ASCT as well as tandem ASCT. 4,23,39,45,52 While sequential HDCT and ASCT has not been shown to be a superior approach, for those patients with particularly poor prognoses, Devillier et al describe 43% PFS at 5 years for those subjects who were PET positive prior to tandem ASCT compared to 0% for those with positive PET scans prior to single ASCT. 53 PET status prior to ASCT was the most predictive prognostic factor in this analysis.…”