High-dose etoposide and melphalan, and autologous bone marrow transplantation for patients with advanced Hodgkin's disease: importance of disease status at transplant.

Crump, Michael; Smith, Anne Marie; Brandwein, Joseph; Couture, Félix; Sherret, Henriette; Sutton, David; Scott, Joseph; McCrae, J; Murray, Cindy; Pantalony, Dominic

doi:10.1200/jco.1993.11.4.704

Cited by 156 publications

(101 citation statements)

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“…In refractory patients pooled with complete responders (Ͻ12 months), high-dose chemotherapy with reinfusion of HSC yielded CR rates of 40-80% with approximately 40% of patients free of disease at 3 years. [15][16][17][18][19][20][21][22][23][24][25] High-dose chemotherapy with BMT is particularly appealing since some patients with disease refractory to conventional-dose chemotherapeutic regimens can be cured. 16,24,25 The BNLI compared standard salvage chemotherapy to high-dose chemotherapy with bone marrow transplantation and found higher event-free survival in the high-dose chemotherapy group.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…This is in accordance with previous studies which included selected patients treated with high-dose regimens. [15][16][17]23,24,[26][27][28][29][30] The various conditioning regimens used in our patients were not compared because patient numbers were small. Although our series is rather heterogeneous with respect to the chemotherapy conditioning regimens, none of these regimens have been shown to be superior.…”

Section: Discussionmentioning

confidence: 99%

“…31 Of the various prognostic factors identified for long-term disease-free survival in high-dose chemotherapy trials, one of the most frequently found is the chemosensitivity of HD at the time of transplantation. 16,24,[27][28][29][30] Salvage chemotherapy before BMT could therefore play an important role in the curability of patients with primary refractory or relapsed HD.We report here the results of a phase II trial of the VIP regimen for patients in whom intensification was envisaged early on in the course of therapy. This treatment was offered in unselected heavily pre-treated patients with poor prognosis Hodgkin's disease who were potentially eligible (aged less than 60 year, no prior extensive bone marrow irradiation and no medical contradiction) for intensive ther-…”

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confidence: 99%

“…23 Prognostic factors allowing the identification of a subgroup of patients who would particularly benefit from highdose therapy have been extensively sought. 16,24,[27][28][29][30] Discrepancies persist regarding their legitimacy probably due to non-homogeneous patient characteristics and selection in the different cohorts studied. 31 Of the various prognostic factors identified for long-term disease-free survival in high-dose chemotherapy trials, one of the most frequently found is the chemosensitivity of HD at the time of transplantation.…”

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VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refractory Hodgkin’s disease

Ribrag

Nasr

Bouhris

et al. 1998

Bone Marrow Transplant

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Summary:Forty-two patients with refractory (15 patients) or relapsed (27 patients) Hodgkin's disease (HD) were included in a prospective single center study evaluating the efficacy of a regimen VIP combining etoposide 75 mg/m 2 /day days 1-5, ifosfamide 1.2 g/m 2 /day days 1-5 and cisplatinum 20 mg/m 2 /day days 1-5, one course every 4 weeks as salvage therapy in patients with refractory or relapsed Hodgkin's disease, potentially eligible for high-dose chemotherapy with reinjection of hematopoietic stem cells (HSC). If patients were considered chemosensitive after two courses of VIP, high-dose chemotherapy followed by the reinjection of HSC was planned. After two courses of VIP, 67% achieved an objective response including 38% complete responses. Overall, 28 patients went on to high-dose therapy with reinjection of HSC, and 46% of grafted patients are in a sustained complete remission. When the overall patient population is considered, 33% are in complete remission (CR) with a median follow-up of 37 months. A CR of less than 12 months and refractory disease were associated with a poor survival. These results showed that the VIP regimen is effective in relapsed or refractory HD and allows high-dose therapy to be given in the case of most responding patients. However, results in patients with refractory disease or a first complete remission of less than 12 months need to be further improved. Keywords: Hodgkin's disease; salvage therapy; VIP; etoposide; ifosfamide; cisplatinumThe prognosis for patients with Hodgkin's disease (HD) has dramatically improved with the use of modern extended-field radiotherapy and/or chemotherapy. With first-line chemotherapy, up to 80% of patients with advanced Hodgkin's disease achieve a complete remission (CR). 1-5 Despite optimal initial treatment, 20-50% of patients fail to enter remission or will relapse after achieving a complete response. [1][2][3][4][5][6][7] It has long been stated that patients who relapse after a first remission can be divided into two groups according to the length of their first remission. When patients relapse more than 1 year after the end of their first-line therapy, as many as 85% of them achieve a second complete remission when the same drug combination is used. 8-10 However, recent reports have shown that long-term disease-free survival at 15 years is achieved in only 20% of these favorable relapses. 8 Conversely, when patients relapse less than 12 months after their first CR or when they do not achieve a first CR, the results of conventional salvage therapy are worse and few long-term survivors are expected. 7,8,[11][12][13][14] High-dose chemotherapy followed by autologous hematopoietic rescue was considered a viable option because of good results achieved in a series of phase II trials. In refractory patients pooled with complete responders (Ͻ12 months), high-dose chemotherapy with reinfusion of HSC yielded CR rates of 40-80% with approximately 40% of patients free of disease at 3 years. [15][16][17][18][19][20][21][22][23][24][25] High-dose chemo...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refractory Hodgkin’s disease

Ribrag

Nasr

Bouhris

et al. 1998

Bone Marrow Transplant

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What is the optimal treatment volume in Hodgkin's disease patients undergoing high-dose chemotherapy and adjuvant radiation therapy?

Mundt

Connell

Mansur

1999

Radiat. Oncol. Invest.

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To determine the optimal treatment volume in Hodgkin's disease patients undergoing high‐dose chemotherapy (HDCT) and radiation therapy (RT), failure sites were reviewed in 56 patients. Twenty‐one (38%) received involved‐field RT (IFRT) before or after HDCT encompassing sites of prior disease. Failure sites were designated as previously involved (old) or uninvolved (new) sites. Seven patients (12%) died in the immediate post‐HDCT period, leaving 49 evaluable (median follow‐up, 41 months). Twenty‐five patients (51%) relapsed (14 HDCT, 11 HDCT + IFRT): seven (28%) in old, eight (32%) in new, and ten (40%) in old and new sites. Six of the seven who relapsed in old sites received HDCT alone, whereas seven of the eight who relapsed in new sites received IFRT. Relapse in old sites was particularly common in patients failing to achieve a complete response. The most common new failure site was nodal, occurring in 11 patients and was primarily (10/11) adjacent to an old site. Although it controls prior disease, IFRT is insufficient in Hodgkin's disease patients undergoing HDCT. Relapse is common in new nodal sites and is primarily adjacent to prior sites. These results suggest that extended‐field RT encompassing old and adjacent uninvolved nodal sites may be the optimal treatment volume in these patients. Radiat. Oncol. Invest. 7:353–359, 1999. © 1999 Wiley‐Liss, Inc.

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Autologous and Allogeneic Hematopoietic Cell Transplantation for Hodgkin's Disease

Bierman¹,

Nademanee²

2003

Thomas' Hematopoietic Cell Transplantation

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High-dose etoposide and melphalan, and autologous bone marrow transplantation for patients with advanced Hodgkin's disease: importance of disease status at transplant.

Abstract: Etoposide and melphalan is an effective and well-tolerated intensive therapy regimen in advanced Hodgkin's disease. Patients in complete remission after conventional-dose salvage therapy transplanted with this regimen enjoy superior long-term DFS.

Cited by 156 publications

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VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refractory Hodgkin’s disease

VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refractory Hodgkin’s disease

What is the optimal treatment volume in Hodgkin's disease patients undergoing high-dose chemotherapy and adjuvant radiation therapy?

Autologous and Allogeneic Hematopoietic Cell Transplantation for Hodgkin's Disease

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