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Early intensive therapy with autologous stem cell transplantation in high-risk Hodgkin's disease: long-term follow-up in 35 cases
- Source :
- Leukemialymphoma. 30(3-4)
- Publication Year :
- 1998
-
Abstract
- Thirty-five adult patients with high-risk HD (HD) defined by (1) Ann Arbor stage IV or bulky nodal disease (tumor/thorax ratio > 0.45) and (2) no or partial response (PR) (< 75%) to the initial 3 courses of ABVD, received an early intensive therapy with autologous stem cell transplantation (ASCT). Thirty patients were considered as partial responders and 5 as refractory to initial chemotherapy. Conditioning regimen consisted of chemotherapy alone (CBV in 11 patients before 1993, BEAM in 13 patients since 1993) followed by adjuvant radiotherapy: 40 Gy) on the initial sites of bulky disease, or 12 Gy total body irradiation plus 120 mg/kg cyclophosphamide in 11 patients with disseminated extra-nodal disease. All 30 patients in PR at the time of ASCT experienced prolonged complete remission (CR). One patient died in CR from an acute myocardial infarction 48 months after ASCT. Four out of the 5 patients with refractory disease at the time of ASCT experienced rapid progression of HD leading to death in 3 cases. After 6 years of CR post-ASCT, the last refractory patient died of myelodysplastic syndrome diagnosed 2 years after intensive therapy. With a median follow-up for surviving patients of 51 months (range: 11-111), the cumulative probability of 8-year overall survival is 75.6% for the entire group of patients, 94.1% for the chemosensitive ones, and 0% for the primary refractory (P < .0001). The cumulative probability of 8-year event-free survival is 79.9% for the entire group of patients, 94.1% for the chemosensitive ones, and 0% for the primary refractory (P < .0001). We conclude that early intensive therapy with ASCT is feasible in patients with high-risk HD and induces a high cure rate in chemosensitive patients. In primary refractory patients, new therapeutic approaches are warranted.
- Subjects :
- Adult
Male
Cancer Research
medicine.medical_specialty
Transplantation Conditioning
Cyclophosphamide
Adolescent
medicine.medical_treatment
Hematopoietic stem cell transplantation
Transplantation, Autologous
Autologous stem-cell transplantation
Refractory
Recurrence
Risk Factors
medicine
Humans
Prospective Studies
Antineoplastic Agents, Alkylating
Chemotherapy
business.industry
Hematopoietic Stem Cell Transplantation
Hematology
Total body irradiation
Middle Aged
Combined Modality Therapy
Hodgkin Disease
Surgery
Transplantation
Treatment Outcome
Oncology
ABVD
Female
business
medicine.drug
Follow-Up Studies
Subjects
Details
- ISSN :
- 10428194
- Volume :
- 30
- Issue :
- 3-4
- Database :
- OpenAIRE
- Journal :
- Leukemialymphoma
- Accession number :
- edsair.doi.dedup.....e84130da7efce19b04bedd2640ab2605