© 2005 European Society for Medical Oncology
Original article |
Cologne high-dose sequential chemotherapy in relapsed and refractory Hodgkin lymphoma: results of a large multicenter study of the German Hodgkin Lymphoma Study Group (GHSG)
1 First Department of Internal Medicine, University Hospital Cologne; 2 Second Medical Hospital, Carl-Thiem-Hospital Cottbus; 3 University Hospital Charitè Berlin, Section for Hematology/Oncology; 4 Department of Internal Medicine, Städtische Kliniken Gummersbach; 5 Third Medical Department, Clinic for Hematology/Oncology Hannover-Siloah; 6 Section for Hematology/Oncology, University Hospital Hamburg-Eppendorf; 7 Section for Hematology/Oncology, University Hospital Lübeck; 8 Department of Internal Medicine, Klinikum Oldenburg, II; 9 Department of Medicine, Hematology and Oncology, University Hospital Münster Germany
Correspondence to: Dr A. Josting, First Department of Internal Medicine, University Hospital Cologne, Joseph-Stelzmann-Str 9, 50924 Cologne, Germany. Email: andreas.josting{at}uni-koeln.de
Background: We designed a dose- and time-intensified high-dose sequential chemotherapy regimen for patients with relapsed and refractory Hodgkin lymphoma (HD).
Patients and methods: Eligibility criteria included age 18–65 years, histologically proven primary progressive (PD) or relapsed HD. Treatment consisted of two cycles DHAP (dexamethasone, high-dose cytarabine, cisplatinum); patients with chemosensitive disease received cyclophosphamide followed by peripheral blood stem cell harvest; methotrexate plus vincristine, etoposide and BEAM plus peripheral blood stem cell transplantation (PBSCT).
Results: A total of 102 patients (median age 34 years, range 18–64) were enrolled. The response rate was 80% (72% complete response, 8% partial response). With a median follow-up of 30 months (range 3–61 months), freedom from second failure (FF2F) and overall survival (OS) were 59% and 78% for all patients, respectively. FF2F and OS for patients with early relapse were 62% and 81%, for late relapse 65% and 81%; for PD 41% and 48%, and for multiple relapse 39% and 48%, respectively. In multivariate analysis response after DHAP (P <0.0001) and duration of first remission (PD and multiple relapse versus early and late relapse; P=0.0127) were prognostic factors for FF2F. Response after DHAP (P <0.0081), duration of first remission (P=0.0017) and anemia (P=0.019) were significant for OS.
Conclusion: Based on the promising results of this study, a prospective randomized European intergroup study was started comparing this intensified regimen with two courses of DHAP followed by BEAM (HD-R2 protocol).
Key words: autologous transplantation, Hodgkin's lymphoma, sequential high-dose chemotherapy
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