Annals of Oncology 6:543-550, 1995
© 1995 European Society for Medical Oncology
research-article |
The MINE regimen as intensive salvage chemotherapy for relapsed and refractory Hodgkin's disease
1Groupe d'Etudes des Lymphomes de I'Adulte, Hôpital Saint-Louis Paris
2Centre Hospitalier Lyon-Sud Pierre Bénite
3Department of Pathology, Hôpital Edouard-Herriot Lyon
4Hôpital Huriez Lille
5Hôpital de la Salpétrière
6Hôpital d'lnstruction des Armées du Val de Gr
ce Paris
7Centre Hospitalier-Universitaire Caen
8Hôpital Saint-Antoine Paris
9French Society of Pediatric Oncology, Institut Gustave Roussy Villejuif, France
Correspondence to: Dr. C. Fermé GELA, Centre Hayem, Hôspitals Saint-Louis, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
BACKGROUND: Relapsed or refractory Hodgkin's disease (HD) patients were treated with an intensive salvage regimen (MINE) prior to high-dose therapy (HDT) with hematopoietic stem cell support.
PATIENTS AND METHODS: One hundred HD patients who either failed to respond to a front-line chemotherapy regimen (induction failure, n—41) or relapsed (untreated relapse, n—54; resistant relapse, n—5) were treated with the MINE regimen. Each course of MINE comprised mitoguazone 500 mg/m2 on days 1 and 5, ifosfamide 1500 mg/m2/d from day 1 to day 5, vinorelbine (Navelbine®) 15 mg/m2 on days 1 and 5, and etoposide 150 mg/m2/d from day 1 to day 3. At least two courses were given at 4-week intervals. Then, 72 patients received HDT followed by hematopoietic stem cell support.
RESULTS: After MINE salvage, 34 patients achieved a complete response (CR) and 39 a partial response, yielding an overall response rate of 75%. Patients with untreated relapse had a 92.5% response rate and those with resistant relapse or induction failure a 53% response rate. A total of 58 patients reached a CR at the end of all treatments; 12 of them relapsed. Sixty-six patients were alive with a median follow-up of 26 months, including 46 patients in CR. The 2-year survival rate for the entire group was 59%. By univariate analysis, patients with an interval between their last treatment and salvage longer than 12 months, untreated relapse, or good performance status at salvage are shown to have longer survivals. The main toxic effects were neutropenia, thrombo-cytopenia, and infectious episodes. Three patients died of MINE-related complications and three after HDT.
CONCLUSION: Given early in the course of progressive HD, the MINE regimen reduced tumor burden in a high proportion of patients with relapsed or refractory disease. Responding patients further intensified with HDT have a better outcome than those who have not responded to salvage treatment.
Hodgkin's disease, salvage therapy
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