Front-line high-dose therapy with autologous stem cell transplantation for high risk Hodgkin's disease: comparison with combined-modality therapy

Abstract

Summary:This retrospective study compares high-dose therapy (HDT) with autologous stem cell transplantation and combined-modality treatment (CT) as a first-line therapy for Hodgkin's disease (HD) for patients with both a clinical stage (CS) IV and/or a mediastinal mass у0.45 of the thoracic diameter (MM у0.45) at diagnosis, and an incomplete response after the first-line chemotherapy. Data on 42 grafted patients (GP) in Nantes Hospital, France and on 108 combined-modality treated patients (CTP) from two protocols of the GOELAMS group, France (POF 81 and H90) was analyzed. Both groups were comparable except for pulmonary disease in excess in the grafted group (P ‫؍‬ 0.01). Among GP, 95% were in complete response at the end of first-line treatment and 77% among CTP. Median follow-up was 53 months (range, 7 to 128 months) for GP and 88 months (range, 25 to 181 months) for CTP. The 5-year freedom from progression (FFP) and event-free survival (EFS) rates were better for GP (87% vs 55% for FFP: P ‫؍‬ 0.0004 and 81% vs 51% for EFS: P ‫؍‬ 0.0004) whereas the overall survival (OS) rates did not differ significantly (85% for GP vs 71% for CTP: P ‫؍‬ 0.06). Similar results were obtained for the groups with a response у50% after initial chemotherapy: 91% vs 65% for FFP, P ‫؍‬ 0.01; 87% vs 61% for EFS, P ‫؍‬ 0.02; and 92% vs 77% for OS, P ‫؍‬ 0.2; and for the groups with a response Ͻ50%: 80% vs 22% for FFP, P ‫؍‬ 0.0003; 72% vs 13% for EFS, P ‫؍‬ 0.0001; and 76% vs 46% for OS, P ‫؍‬ 0.04. This study shows a better control of the disease with HDT.

Early versus late intensification for patients with high‐risk Hodgkin lymphoma—3 Cycles of intensive chemotherapy plus low‐dose lymph node radiation therapy versus 4 cycles of combined doxorubicin, bleomycin, vinblastine, and dacarbazine plus myeloablative chemotherapy with autologous stem cell transplantation

“…Arm A of the trial was consisted of a conventional chemotherapy regimen (4 cycles of ABVD) followed by a late myeloablative chemotherapy regimen (BEAM). We chose these experimental treatments because they were among the most successful for patients with refractory disease or early recurrences 8, 12. Patients in both Arm V and Arm A had the same complete remission rates (89% and 88.2%, respectively) and had similar 5‐year FFTF rates (78.9 ± 8.9% and 74.9 ± 9.8%, respectively) and OS rates (86.8 ± 7.8% and 85.9 ± 8.2%, respectively).…”

“…The other treatment arm ( Arm A ) consisted of 4 cycles of ABVD followed by an adjuvant myeloablative chemotherapy regimen of BCNU, etoposide, cytarabine, and melphalan (BEAM) associated with autologous stem cell transplantation (ASCT). This treatment approach already had been tested in patients with refractory or relapsing HL by different groups,9–11 including ours 12. In this article, we report the 5‐year results from this multicenter, phase 2, randomized study (the H97‐HR trial).…”

The Role of Autologous and Allogeneic Hematopoietic Stem Cell Transplantation for Hodgkin Lymphoma

“…17 High-risk patients (mediastinal mass ≥ 45% of thoracic diameter, stage IV disease, or a incomplete response to initial frontline chemotherapy) had a better 5-year freedom from progression rate compared with conventional therapy alone (87% vs. 55%, respectively; P = .0004); however, the overall survival rate was not different (85% for ASCT vs. 71% for conventional therapy; P = .06). ASCT was superior in patients with greater than 50% tumor reduction (freedom from progression, 91% for ASCT vs. 65% for combined modality, and overall survival, 92% vs. 77%, respectively [ P = .02]) and for the group with less than a 50% response to initial therapy (freedom from progression, 80% for ASCT vs. 22% for combined modality [ P = .0003], and overall survival, 76% vs. 46%, respectively [ P = .04]).…”

Hodgkin's disease and non-Hodgkin's lymphoma

“…49 On the Cologne high-dose sequential protocol, patients with primary progressive or relapsed Hodgkin's disease received two cycles of DHAP, followed by 4 g/m 2 cyclophosphamide and peripheral blood stem cell mobilization. Forty two patients who had been autografted were compared to 108 patients who had received combined-modality treatment from two protocols of the GOELAMS group.…”