Second-line salvage chemotherapy for transplant-eligible patients with Hodgkin's lymphoma resistant to platinum-containing first-line salvage chemotherapy.

Abstract

BACKGROUND:

The management of patients with relapsed or refractory Hodgkin's lymphoma who achieve less than a partial response to first-line salvage chemotherapy is unclear. The objective of this study was to evaluate response and outcomes to second-line salvage and autologous stem cell transplantation in patients not achieving a complete or partial response to platinum-containing first-line salvage chemotherapy.

DESIGN AND METHODS:

Consecutively referred transplant-eligible patients with relapsed/refractory Hodgkin's lymphoma after primary chemotherapy received gemcitabine, dexamethasone, and cisplatin as first salvage chemotherapy. Those achieving a complete or partial response, and those with a negative gallium scan and stable disease with bulk <5 cm proceeded to high-dose chemotherapy and autologous stem cell transplantation. Patients with progressive disease or stable disease with a positive gallium scan or bulk ≥ 5 cm were given second salvage chemotherapy with mini-BEAM (carmustine, etoposide, cytarabine, melphalan). Patients who responded (according to the same definition) proceeded to autologous stem cell transplantation.

RESULTS:

One hundred and thirty-one patients with relapsed/refractory Hodgkin's lymphoma received first-line salvage gemcitabine, dexamethasone, and cisplatin; of these patients 99 had at least a partial response (overall response rate 76%). One hundred and twelve (85.5%) patients proceeded to autologous stem cell transplantation, while the remaining 19 (14.5%) patients received mini-BEAM. Among these 19 patients, six had at least a partial response (overall response rate 32%), and nine proceeded to autologous stem cell transplantation. The remaining ten patients received palliative care. Seven of the nine patients transplanted after mini-BEAM had a subsequent relapse. Patients receiving second salvage mini-BEAM had poor outcomes, with a 5-year progression-free survival rate of 11% and a 5-year overall survival rate of 20%.

CONCLUSIONS:

Patients who require a second salvage regimen to achieve disease control prior to autologous stem cell transplantation have a relatively poor outcome and should be considered for alternative treatment strategies.

• Authors: Diego Villa, Tara Seshadri, Noemi Puig, Christine Massey, Richard Tsang, Armand Keating, Michael Crump, John Kuruvilla
• Journal: Haematologica (Haematologica) Vol. 97 Issue 5 Pg. 751-7 (May 2012) ISSN: 1592-8721 [Electronic] Italy
• PMID: 22180434 (Publication Type: Journal Article)

Chemical References

• Cytarabine
• Etoposide
• Melphalan
• Carmustine

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carmustine (therapeutic use)
• Cytarabine (therapeutic use)
• Drug Resistance, Neoplasm
• Etoposide (therapeutic use)
• Female
• Hematopoietic Stem Cell Transplantation
• Hodgkin Disease (mortality, therapy)
• Humans
• Male
• Melphalan (therapeutic use)
• Middle Aged
• Neoplasm Recurrence, Local (mortality, therapy)
• Prognosis
• Prospective Studies
• Remission Induction
• Retrospective Studies
• Salvage Therapy
• Survival Rate
• Transplantation, Autologous
• Young Adult