PURPOSE:High-dose chemotherapy (HDCT) followed by autologous stem-cell transplantation (PBSCT) has become the standard treatment for patients with relapsed Hodgkin's lymphoma (HL). The intensity of treatment needed is unclear. This European intergroup study evaluated the impact of sequential high-dose chemotherapy (SHDCT) before myeloablative therapy. PATIENTS AND METHODS: Patients with histologically confirmed, relapsed HL were treated with two cycles of dexamethasone, cytarabine, and cisplatin, and those without disease progression were randomly assigned. In the standard arm (A), patients received myeloablative therapy with carmustine, BEAM (carmustine, etoposide, cytarabine, and melphalan) followed by PBSCT. Patients in the experimental arm (B) also received sequential cyclophosphamide, methotrexate, and etoposide in high-doses before BEAM. Freedom from treatment failure (FFTF) was the primary end point. Remission rates, overall survival (OS), and toxicity of treatment were secondary end points. RESULTS:From a total of 284 patients included, 241 responding patients were randomly assigned after two cycles of dexamethasone, cytarabine, and cisplatinum. Patients treated in arm B had longer treatment duration and experienced more toxicity and protocol violations (P < .05). Mortality was similar in both arms (20% and 18%). With a median observation time of 42 months, there was no significant difference in terms of FFTF (P = .56) and OS (P = .82) between arms. FFTF at 3 years was 62% (95% CI, 56% to 68%) and OS was 80% (95% CI, 75% to 85%). Patients with stage IV, early relapse, multiple relapse, anemia, or B symptoms had a higher risk of recurrence (P < .001). CONCLUSION: Compared with conventional high-dose chemotherapy, additional SHDCT is associated with more adverse effects and does not improve the prognosis of patients with relapsed HL.
RCT Entities:
PURPOSE: High-dose chemotherapy (HDCT) followed by autologous stem-cell transplantation (PBSCT) has become the standard treatment for patients with relapsed Hodgkin's lymphoma (HL). The intensity of treatment needed is unclear. This European intergroup study evaluated the impact of sequential high-dose chemotherapy (SHDCT) before myeloablative therapy. PATIENTS AND METHODS: Patients with histologically confirmed, relapsed HL were treated with two cycles of dexamethasone, cytarabine, and cisplatin, and those without disease progression were randomly assigned. In the standard arm (A), patients received myeloablative therapy with carmustine, BEAM (carmustine, etoposide, cytarabine, and melphalan) followed by PBSCT. Patients in the experimental arm (B) also received sequential cyclophosphamide, methotrexate, and etoposide in high-doses before BEAM. Freedom from treatment failure (FFTF) was the primary end point. Remission rates, overall survival (OS), and toxicity of treatment were secondary end points. RESULTS: From a total of 284 patients included, 241 responding patients were randomly assigned after two cycles of dexamethasone, cytarabine, and cisplatinum. Patients treated in arm B had longer treatment duration and experienced more toxicity and protocol violations (P < .05). Mortality was similar in both arms (20% and 18%). With a median observation time of 42 months, there was no significant difference in terms of FFTF (P = .56) and OS (P = .82) between arms. FFTF at 3 years was 62% (95% CI, 56% to 68%) and OS was 80% (95% CI, 75% to 85%). Patients with stage IV, early relapse, multiple relapse, anemia, or B symptoms had a higher risk of recurrence (P < .001). CONCLUSION: Compared with conventional high-dose chemotherapy, additional SHDCT is associated with more adverse effects and does not improve the prognosis of patients with relapsed HL.
Authors: Achim Rothe; Stephanie Sasse; Max S Topp; Dennis A Eichenauer; Horst Hummel; Katrin S Reiners; Markus Dietlein; Georg Kuhnert; Joerg Kessler; Carolin Buerkle; Miroslav Ravic; Stefan Knackmuss; Jens-Peter Marschner; Elke Pogge von Strandmann; Peter Borchmann; Andreas Engert Journal: Blood Date: 2015-04-17 Impact factor: 22.113
Authors: Frank Kroschinsky; Denise Röllig; Barbara Riemer; Michael Kramer; Rainer Ordemann; Johannes Schetelig; Martin Bornhäuser; Gerhard Ehninger; Mathias Hänel Journal: J Cancer Res Clin Oncol Date: 2019-09-28 Impact factor: 4.553
Authors: Eileen P Smith; Hongli Li; Jonathan W Friedberg; Louis S Constine; Lisa M Rimsza; James R Cook; Ginna G Laport; Leslie L Popplewell; Leona A Holmberg; Sonali M Smith; Michael LeBlanc; Stephen J Forman; Richard I Fisher; Patrick J Stiff Journal: Biol Blood Marrow Transplant Date: 2017-12-28 Impact factor: 5.742
Authors: Nancy L Bartlett; Alex F Herrera; Eva Domingo-Domenech; Amitkumar Mehta; Andres Forero-Torres; Ramon Garcia-Sanz; Philippe Armand; Sumana Devata; Antonia Rodriguez Izquierdo; Izidore S Lossos; Craig Reeder; Taimur Sher; Robert Chen; Sylvia E Schwarz; Leila Alland; Andras Strassz; Kim Prier; Cassandra Choe-Juliak; Stephen M Ansell Journal: Blood Date: 2020-11-19 Impact factor: 22.113