Long-term Outcome of Hodgkin Disease Patients Following High-Dose Busulfan, Etoposide, Cyclophosphamide, and Autologous Stem Cell Transplantation

Abstract

Busulfan (Bu)-based preparative regimens have not been extensively investigated in Hodgkin disease (HD). The purposes of this study were to investigate the toxicity and efficacy of a novel preparative regimen of Bu 14 mg/kg, etoposide 50-60 mg/kg, and cyclophosphamide 120 mg/kg in patients with primary refractory and relapsed HD. One hundred twenty-seven patients with a median age of 33 years (range, 14-67 years) underwent transplantation. The regimen was well tolerated, with 5.5% treatment-related mortality at 100 days after transplantation. With a median follow up of 6.7 years, the 5-year progression-free survival was 48 +/- 5%, and the 5-year overall survival was 51 +/- 5%. A Cox proportional hazards model identified refractory disease at time of transplantation as the only significant factor affecting relapse and overall survival, whereas disease bulk >10 cm affected overall survival. Five patients died between 5.3 and 9.3 years of late complications, including secondary myelodysplasia or acute myeloid leukemia, secondary solid malignancies, and pulmonary toxicity. This novel Bu regimen is comparable to other radiation-free preparative regimens in its effectiveness in the control of HD and with a low-risk of early treatment-related mortality.

Pharmacokinetic-Directed High-Dose Busulfan Combined with Cyclophosphamide and Etoposide Results in Predictable Drug Levels and Durable Long-Term Survival in Lymphoma Patients Undergoing Autologous Stem Cell Transplantation

“…dosing, similar to the conclusions of a randomized study of PK-directed IV4 versus IV16 conditioning regimens (n 5 30/group) [19]. Our reported 5-year OS in the cohort of patients receiving oral busulfan is consistent with a previous report in HL patients with a median age of 33 [20], and is corroborated by a recent study using the United States Surveillance, Epidemiology, and End Results data for patients with diffuse large B-cell lymphoma [21]. A phase II clinical trial currently being pursued is assessing the toxicity and efficacy of PK-directed once-daily i.v.…”

Evaluation of Autologous Hematopoietic Stem Cell Transplantation Results of the Patients with Hodgkin Lymphoma: A Single Center Experience

“…All patients who were alive and disease free at 5 years were still in remission at 10 years post-transplant. 7,[14][15] This was similar in our study, none of the patients relapsed after 5 years.…”

“…15,[17][18][19] In our study, remission status at transplantation was found to be statistically significant for OS (p= 0.031). Different studies had different results about remission status and that could be grounded on applying different chemotherapy regimens before transplantation.…”

Carmustine replacement in intensive chemotherapy preceding reinjection of autologous HSCs in Hodgkin and non-Hodgkin lymphoma: a review

“…This agent has been used as an alternative to classic conditioning regimens based on carmustine to improve the tolerance/effectiveness relationship [45][46][47][48] for patients with NHL [49][50][51] or multiple myeloma (Table 3a and Table 3b). [52][53][54] In adults, thiotepa is preferentially indicated for the treatment of lymphoid malignancies with central nervous system (CNS) localization.…”