Treatment of young relapsed Hodgkin's disease patients with high-dose chemotherapy followed by peripheral blood stem cell transplantation.

Four patients less than 20 years of age with Hodgkin's disease, who had developed either second or third relapse, were treated with high-dose chemotherapy followed by peripheral blood stem cell transplantation (PBSCT). Peripheral blood stem cells (PBSC) were collected after the administration of high-dose cytosine arabinoside (HD-AraC, 1g/m2 x 4). The conditioning regimen for PBSCT contained cyclophosphamide (50mg/m2 x 4), etoposide (150mg/m2 x 6) and ranimustine (250mg/dose x 1) (CVM regimen). A significant tumor regression was thus obtained after HD-AraC in 3 cases. The amount of PBSC harvested ranged from 1.2 to 4.5 x 10(5)/kg CFU-GM. Several cycles of conventional therapy were performed prior to the transplantation. PBSCT was done only after achieving a complete remission (CR) in 3 cases, but during relapse in another case. All patients showed both a rapid and sustained hematological recovery without any critical side effects. After this treatment, the 3 patients who were in CR at transplantation maintained a CR for 27, 26, and 4 months, respectively, while another developed a bone relapse despite achieving a CR by PBSCT. These results suggest that a combination of HD-AraC and CVM followed by PBSCT is therefore considered to be beneficial in the treatment of relapsed Hodgkin's disease.