ESAP-Lenalidomide - a Highly Active Regimen in Refractory or Relapsed Hodgkin's Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4797-4797
Author(s):  
Adrian Tempescul ◽  
Jean-Christophe Ianotto ◽  
Gaelle Guillerm ◽  
Christian Berthou
Keyword(s):  
Fdg Pet ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Residual Disease ◽  
Single Agent ◽  
Salvage Chemotherapy ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Salvage Regimen ◽  
Highly Active

Abstract Abstract 4797 Hodgkin's disease (HD) is a commonly cured lymphoma. Unfortunately between 10 and 20% of patients are refractory or relapse after a first line of treatment. There is evidence that for these patients the best approach is salvage chemotherapy followed by high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT). Existing salvage regimens of chemotherapy, mainly based on platines or aracytine, have a response rate between 60-85%. Usually is associated a toxicity resulting in delay of chemotherapy or dose reduction. It is very important to achieve complete remission before HDC/ABSCT. It has been proved that 18-FDG PET has a predictive value on Hodgkin's lymphoma. Into the pathophysiology of HD are implicated various cytokines like IL6, IL12, IL13, NFkB and angiogenic factors. Immunomodulatory drugs have an impact on microenvironment, altering cytokine secretion and the expression of adhesion molecules which can result in apoptosis of malignant B-cell. Lenalidomide, having both immunomodulatory and antiangiogenic activity, proved to be highly active into the treatment of myeloma and some forms of non-Hodgkin's lymphoma. Into a phase two studies, Lenalidomide administrated as a single agent, proves to be also active into the refractory or relapsed Hodgkin's lymphoma. During a period of one year, we identified eight patients with refractory ore relapsed HD. We have treated these patients with classical salvage chemotherapy regimen – ESAP- in which we associated Lenalidomide, administrated continuously during the whole period of treatment. We evaluate the response by 18-FDG PET, early, after two or three cycles of ESAP-Lenalidomide association. We obtained seven complete remissions and one very good partial remission (minimal residual disease in PET SCAN). The toxicity was essentially hematological, neutropenia and trombocytopenia. This small study proves that Lenalidomide, a new drug with both immunomodulatory and antiangiogenic effects, associated to a classical salvage regimen of chemotherapy is highly active on refractory or relapsing Hodgkin's lymphoma. Disclosures: No relevant conflicts of interest to declare.

A Multicenter Phase II Trial of Etoposide, Methylprednisolone, High-Dose Cytarabine, and Oxaliplatin (ESHAOx) for Patients with Refractory/Relapsed Aggressive Non-Hodgkin’s Lymphoma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3446-3446
Author(s):  
Sun Jin Sym ◽  
Hye Jin Kang ◽  
Seung-Hyun Nam ◽  
Hoyoung Kim ◽  
Seok Jin Kim ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Single Agent ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Hematologic Toxicity ◽  
Salvage Regimen ◽  
Hematopoietic Stem ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
High Dose Cytarabine

Abstract Etoposide (E), methylprednisolone (S), high-dose cytarabine (HA), and cisplatin (P) (ESHAP) combination is commonly used salvage regimen for non-Hodgkin’s lymphoma (NHL). Oxaliplatin (Ox), a new platinum derivative, showed substantially different cytotoxic activity and adverse effects from both cisplatin and carboplatin. In addition, single-agent oxaliplatin was reportedly active in patients with NHL. We conducted to investigate the efficacy and toxicity of ESHAOx combination, substituting oxaliplatin for cisplatin in ESHAP combination, for relapsed/refractory aggressive NHL patients. Main eligibility criteria included aggressive NHL and failure to achieve a complete remission or recurrent disease after previous chemotherapy. ESHAOx consisted of E, 40 mg/m2 on days 1 to 4; S, 500 mg on days 1 to 5; HA, 2 g/m2 on day 5; and Ox, 130 mg/m2 on day 1, every 3 weeks. Eligible patients were scheduled to receive a maximum of 6 cycles, and high dose chemotherapy and hematopoietic stem cell rescue allowed. Responses were evaluated every 3 cycles. All patients gave written informed consent before study entry. Between May 2006 and January 2007, 27 patients were enrolled. Nineteen (70%) patients with relapsed, 8 patients with refractory, and 10 (37%) patients with IPI 3–5 were included in this study. A total of 102 cycles were administered for a median number of 4 (range 1–6 cycles) per patient. There were 8 (30%) complete responses and 9 (33%) partial responses, producing an overall response rate of 63% (95% CI, 45–81%). Most common grade 3/4 toxicity of the courses was myelosuppression with including neutropenia (55%) and thrombocytopenia (33%). Non-hematologic toxicity was very favorable. No significant renal and neurotoxicity was demonstrated. There was one treatment-related death due to neutropenic sepsis. The results of ESHAOx combination showed highly antitumor activity and favorable toxicity profile, suggesting it can be used as salvage regimen for relapsed/refractory aggressive NHL patients.

Retreatment with Gemcitabine Still Hold Efficacy in Relapsed Lymphomas.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4751-4751
Author(s):  
Ahmad Jajeh ◽  
Diemanti Tamkus ◽  
Perry Menini ◽  
David Osafo
Keyword(s):  
Stem Cells ◽  
Hodgkin’S Lymphoma ◽  
Single Agent ◽  
Complete Response ◽  
High Dose Chemotherapy ◽  
Salvage Chemotherapy ◽  
Lymphocytic Leukemia ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Durable Response

Abstract Lymphomas are highly sensitive to chemotherapy. Approximately half of the patients with aggressive Non-Hodgkin’s Lymphoma will survive for five years. Patients with diffuse large B-cell type NHL have an expected five years survival( OS) rate of fourty five percent (45%). Approximately more than twenty five percent (25%) of NHL and ten percent 10% of Hodgkin’s Lymphoma HD are refractory to conventional front line therapy. Fifteen to twenty five percent of hodgkin’s lymphoma will relapse after therapy or will not achieve complete response CR. Salvage chemotherapy, radiation and high dose chemotherapy with stem cells collection can cure and achieve durable response in some refractory or relapsed patients. High dose chemotherapy and autologous stem cells transplant is not a feasible options for many of our patients due to lack of medical coverage and co-morbide status. Gemcitabine has been used either as a single agent or in combination at our institute in the treatment of variety of hematological malignancies that failed many lines of therapy. Forty patients were treated; twenty two (55%)NHL, nine patients(19%) with HD, three patients with visceral mycosis fungoides, three patients with advanced chronic lymphocytic leukemia in richter transformation and three with peripheral T cell NHL. Mean age of 45 years. Thirty two males and eight females. Eighty percent were african american. All patients had advanced stage III-IV disease. Complete respose CR and near complete response nCR was seen in eleven patients. Partial response PR seen in nineteen patients, stable disease in six. Total response rate of eighty percent. Five patients relapsed after a year (two 25 years old females with HD, three males with high grade NHL age 52, 60 and 70 respectively). Two patients recieved four cycles and three recieved six cycles. Each cycle constitute of 1 gram per meter square given IV weekly for three weeks and one week rest. All five patients had response, three CR and two PR. In conclusion retreatment with gemcitabine is a valid and safe option. None of the patients had grade 3 or 4 toxicity.

High-dose chemotherapy and peripheral hematopoietic stem cell transplantation in relapsed/refractory Hodgkin’s lymphoma

2018 ◽  
Vol 104 (6) ◽  
pp. 471-475 ◽  
Author(s):  
Mouhammed Kelta ◽  
Jamal Zekri ◽  
Ehab Abdelghany ◽  
Jalil Ur Rehman ◽  
Zahid Amin Khan ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hodgkin’S Lymphoma ◽  
High Dose Chemotherapy ◽  
Salvage Chemotherapy ◽  
Hodgkin's Lymphoma ◽  
Phase Iii ◽  
High Dose

Purpose: High-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) is used to treat patients with relapsed Hodgkin’s lymphoma. In this retrospective study we report our experience with patients who underwent HDCT and ASCT. Methods: All patients ≥15 years old with relapsed/refractory Hodgkin’s lymphoma who underwent HDCT and ASCT between June 2001 and December 2013 were included. Results: Fifty-four patients were identified. Median age at transplant was 22 years (range 15-49 years); 26 were men and 28 were women. Forty-eight patients (89%) underwent HDCT and ASCT after achieving a radiological response to salvage chemotherapy. The rate of radiological complete response to salvage chemotherapy was 13% and reached 50% within 3 months of ASCT in assessable patients. After a median follow-up of 25 months, 31 patients (57%) were still alive with no evidence of relapse or progression. Median event-free survival (EFS) was 24 months (95% CI 8.7-39.3) and 3-year EFS was 56%. Median overall survival (OS) was not reached and 3-year OS was 82.5%. Bulky mediastinal disease at relapse, hemoglobin level, and number of salvage regimens did not significantly impact EFS in univariate and multivariate analyses. After transplantation there was a trend towards longer EFS (30 vs. 24 months; p = 0.36) in patients with a longer time from the end of first-line treatment until relapse (≥12 vs. <12 months). The 100-day transplant-related mortality was 5.5%. Conclusions: HDCT and ASCT for relapsed/refractory Hodgkin’s lymphoma is safe. Our findings are consistent with published phase III results. Longer follow-up is warranted.

FDG-PET in the detection of residual disease and relapse in patients with Hodgkin's lymphoma. Experience from a Swedish centre.

2006 ◽  
Vol 45 (6) ◽  
pp. 743-749 ◽  
Author(s):  
Maria Bjurberg ◽  
Anita Gustavsson ◽  
Tomas Ohlsson ◽  
Eva Brun
Keyword(s):  
Fdg Pet ◽  
Hodgkin’S Lymphoma ◽  
Residual Disease ◽  
Hodgkin's Lymphoma

Characteristics and Outcome of Patients with Acute Myeloid Leukemia (AML) Refractory to One Cycle of High Dose Cytarabine-Based Induction Chemotherapy.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1038-1038
Author(s):  
Farhad Ravandi ◽  
Jorge Cortes ◽  
Stefan Faderl ◽  
Susan O'Brien ◽  
Guillermo Garcia-Manero ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Conflicts Of Interest ◽  
Single Agent ◽  
Salvage Chemotherapy ◽  
High Dose ◽  
Cell Transplant ◽  
Refractory Disease ◽  
Allogeneic Stem Cell Transplant

Abstract Abstract 1038 Poster Board I-60 Background: Outcome of patients (pts) with AML refractory to initial induction is assumed to be poor but the available data is limited. Furthermore, pts refractory to standard dose cytarabine-based regimens may be salvaged with high dose ara-C (HiDaC, defined as daily ara-C dose ≥ 1 g/m2). Information on the outcome of pts refractory to initial HiDaC - based induction is more limited. Aim To better characterize predictors of poor response to HiDaC-based induction and to evaluate the outcome of pts refractory to such induction regimens. Methods: We identified pts treated with induction regimens containing HiDaC at the University of Texas – M D Anderson Cancer Center who did not achieve a compete remission (CR) after one cycle of induction. We examined their pre-treatment characteristics and compared them with similar pts achieving a CR. We also examined their response to salvage chemotherapy and outcome. Results: Among 1179 pts treated with HiDaC-based induction therapy from 1995 to 2009, 285 were primary refractory to one course of induction. Their median age was 59 (range, 18 - 85). Median pretreatment WBC was 9.0 × 109/L (range, 0.3 – 394 × 109/L). Cytogenetics included-5/-7/complex 101 (35%), diploid 85 (30%), other intermediate 98 (34%), favorable 1 (<1%). 165 (58%) pts had antecedent hematological disorder. Induction regimens used included HiDaC with anthracyclines (n=181, 64%), HiDaC with non-anthracycline chemotherapy (fludarabine, clofarabine, topotecan, and troxacitabine) (n=104, 36%) Pts with primary refractory disease were older (Median age 59 vs. 56; p=000004), more likely to have chromosome 5/7 or complex cytogenetic abnormalities (P=0.0001), more likely to have AHD (p=0.0001), and had a higher presentation WBC (P=0.036), but not a higher incidence of FLT3 mutations (p=0.85) than those achieving CR. Primary refractory disease was not more likely with non-anthracycline containing regimens than those with anthracyclines (p=0.58). Salvage chemotherapy included combination chemotherapy in 111 (39%)(non-ara-C regimen in 40, containing ara-C in 71), single agent chemotherapy in 64 (22%), allogeneic stem cell transplant in 22 (8%) and none in 88 (31%). Forty-three (15%) pts responded to salvage including 35 CR and 8 CRp. 114 (58%) pts were resistant and 35 (18%) died; 5 (3%) were lost to follow-up. With a median follow-up of 115 weeks (range 8 – 347 weeks) in pts responding to salvage, 21 pts (7%) were alive and in CR, for at least 6 months including 14 who underwent an allogeneic stem cell transplant (median overall survival for these 21 pts, 30 months; range, 13 to 87 months). Conclusions: Outcome of pts with disease refractory to HiDaC-based induction is poor. Alternative strategies are needed in these pts who are likely to be resistant to standard chemotherapy. Disclosures: No relevant conflicts of interest to declare.

The Role of Surveillance Imaging for the Detection of Relapsed Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4629-4629
Author(s):  
Neta Goldschmidt ◽  
Omer Or ◽  
Martine Klein ◽  
Bella Savitsky ◽  
Ora B. Paltiel
Keyword(s):  
Fdg Pet ◽  
Hodgkin’S Lymphoma ◽  
Clinical Symptoms ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Hodgkin's Lymphoma ◽  
Independent Effect ◽  
Image Detection ◽  
Risk Of Death ◽  
Major Mode

Abstract Abstract 4629 Introduction Up to 30% of patients with Hodgkin's lymphoma (HL) and 60% of patients with aggressive Non-Hodgkin's lymphoma (A-NHL) will relapse after first remission. Early detection of relapse, associated with a low tumor burden, may improve survival. The optimal follow up method - clinical versus imaging - for the detection of relapse has not been clarified. Methods We retrospectively reviewed the files of 125 patients with HL and A-NHL diagnosed between 1.1993 - 1.2009 who relapsed at least one month after the end of initial therapy. We assessed whether relapse was detected by clinical symptoms or by imaging and specifically queried whether recent imaging techniques i.e. [18F] fluorodeoxyglucose positron emission tomography (FDG-PET), have changed the pattern and outcomes of relapsed disease. Results Forty two (34%) patients had HL and 83 (66%) had A-NHL. Of the 125 patients, age was <30 years in 50% of HL and >60 years in 47% of A-NHL patients; 75 (60%) had advanced disease and 50 (40%) had early disease at diagnosis. Seventy patients (56%) relapsed in the first year following treatment, 20 (16%) in the second year and the rest (33, 26%) relapsed thereafter. In 75 (60%) patients, relapse was detected based on patient's symptoms or an abnormal physical finding (clinical detection of relapse, CDR) and in 50 (40%) patients relapse was detected by routine imaging (image detection of relapse, IDR). A significantly higher proportion of A-NHL patients had CDR as opposed to IDR (67% versus 33%), whereas in HL the opposite was found (45% CDR and 55% IDR) (p=0.022). In the years 2001-2009, when FDG-PET was available at our institution, 28% of HL patients had CDR and 72% were diagnosed by IDR (p=0.065). Multiple regression analysis confirmed the independent effect of histology (OR 2.6, 95% CI 1.19-5.69 for HL versus NHL) and period of relapse (OR 2.4, 95% CI 1.1-5.4 for ≥2001 versus '2000) on the probability of IDR. Characteristics at relapse including time to relapse, stage, presence of B symptoms, prognostic score, site of relapse, extranodal involvement and period of relapse did not influence the mode of diagnosing relapse. The overall survival after relapse of all 125 patients did not differ significantly whether they had CDR or IDR. However, in patients with HL (but not in patients with A-NHL), IDR was associated with improved survival (albeit non-significant) (Fig 1). The risk of death was more than twice for HL patients with CDR versus IDR (Hazard ratio (HR) 2.4, 95% CI 0.73-7.63) whereas in A-NHL patients the mode of detection of relapse was not associated with survival (HR 0.91, 95% CI 0.5-1.66). Conclusions These preliminary results show that the major mode of detecting relapses in lymphoma remains the clinical exam and not imaging. However, routine surveillance by imaging may be important in HL as opposed to A-NHL and the use of contemporary imaging modalities, i.e. FDG-PET, may be more sensitive for relapse detection. Although non significant, our findings suggest that image detection of relapse in patients with HL may be associated with improved survival. Disclosures: No relevant conflicts of interest to declare.

Diagnostic Value and Limitations of FDG-PET for the Staging of Childhood Lymphomas.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3658-3658 ◽  
Author(s):  
Edita Kabickova ◽  
Jana Votrubova ◽  
David Sumerauer ◽  
Ester Mejstrikova ◽  
Ondrej Hrusak ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Fdg Pet ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Hodgkin's Lymphoma ◽  
Disease Stage ◽  
Whole Body ◽  
Fatty Tissue ◽  
Fdg Uptake ◽  
Pet Ct

Abstract Abstract 3658 Poster Board III-594 Introduction Positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) has the potential to detect malignant cells by their increased glycolysis. PET can detect early changes, before they are apparent on anatomic imaging. Whole-body PET can also detect lesions at unexpected sites. However, physiologic FDG uptake in non-malignant conditions limits the specificity of PET. PET is predominantly used in adult lymphoma patients, limited number of studies were published dealing with PET and PET/CT in childhood lymphomas. The aim of our study was to assess the usefulness of PET for initial staging of pediatric lymphomas and to evaluate benign pathologic causes of FDG uptake. Patients and methods Over a period of 5 years 86 children and adolescents with lymphoma (58 with Hodgkin's lymphoma, 28 with non-Hodgkin's lymphoma) had complete staging work-up including FDG-PET or PET/CT and were included into this prospective study. Patients were aged 4-19 years, 57 (66%) were boys. No patient had CNS lymphoma infiltration. PET findings were correlated with conventional staging methods (CSM) including CT, ultrasound, and bone marrow examination. Discordant findings were verified by MRI and follow-up radiographic studies including PET. Results PET revealed 40 additional lymphoma manifestations in 34% (26/86) of studies and correctly upstaged 15% (13/86) of patients. Only 2% (2/86) of children were not accurately staged by PET, when PET failed to visualize diffuse bone marrow infiltration (extent of 15% cells) in 1 patient, and missed small pulmonary metastases (≤6 mm) in 1 child. Compared with CSM, PET had significantly higher sensitivity (97% vs. 83%), specificity (100% vs. 89%), and significantly higher accuracy (98% vs. 84%). Physiologic thymic FDG uptake was observed in 15% (13) of patients; diffuse increased FDG bone marrow activity had 22% (19) of children, and intense FDG activity in fatty tissue occurred only in 8% (7) of patients. Conclusions PET imaging was highly sensitive in detecting all subtypes of pediatric lymphomas and has potential to accurately define the disease stage except the lungs, where CT has excellent sensitivity. Understanding of the physiologic FDG biodistribution and benign pathologic causes of FDG uptake is essential for accurate scan interpretation. Supported by grants: IGA NS/9997-4, NS/10480-3, MSM 0021620813 and MZO FNM 2005 Disclosures: No relevant conflicts of interest to declare.

Early Interim 18f-FDG PET In Hodgkin's Lymphoma: Evaluation on 304 Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3879-3879
Author(s):  
Pier Luigi Zinzani ◽  
Luigi Rigacci ◽  
Vittorio Stefoni ◽  
Alessandro Broccoli ◽  
Benedetta Puccini ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Early Recognition ◽  
Early Stage ◽  
Progression Free Survival ◽  
Complete Response ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Advanced Stage ◽  
Interim Pet

Abstract Abstract 3879 Purpose. The use of early (interim) positron emission tomography (PET) restaging during front-line therapy in Hodgkin's lymphoma (HL) has considerably increased in clinical practice as an early recognition of treatment failure allows patients to be addressed to more intensive treatment regimens. Patients and Methods. Between June 1997 and June 2009, 304 newly-diagnosed Hodgkin's lymphoma patients (147 early-stage and 157 advanced-stage) were treated with the ABVD regimen at two Italian institutions. Patients underwent to a PET staging and restaging at baseline, after 2 cycles of therapy and at the end of the treatment. Results. 53 patients showed a positive interim PET and only 13/53 (24.5%) achieved a complete response (CR), whereas 251 patients showed a negative PET and 231/251 (92%) remained in CR. Comparison between interim PET-positive and interim PET-negative patients indicated a significant association between PET findings and 9-year progression-free survival (p=0.0000) and 9-year overall survival (p=0.0000), with a median follow-up of 31 months. Among the early-stage patients, 19 had a positive interim PET and only 4 (21%) achieved a CR; among the 128 negative interim PET patients, 122 (97.6%) obtained a CR. In the advanced-stage subset, 34 patients showed a persistently positive PET (with only 9/34, 26.4% in CR), whereas 123 showed a negative interim PET, with 109 (88.6%) remaining in CR. Conclusions. Our results confirm the role of early PET as a significant step forward for the management of both early and advanced-stage HL patients, offering the potential for an immediate switch to high-dose treatments, if required. Disclosures: No relevant conflicts of interest to declare.

BACOPP-D - An Etoposide-Free Dose-Escalated Polychemotherapy Regimen In Advanced Hodgkin‘s Lymphoma

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1754-1754
Author(s):  
Ralph Naumann ◽  
Diana Kluge ◽  
Annette Haenel ◽  
Katrin Wetzko ◽  
Nadja Friedel ◽  
...  
Keyword(s):  
Acute Toxicity ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Observation Time ◽  
Hodgkin's Lymphoma ◽  
Hypopharyngeal Carcinoma ◽  
Secondary Malignancy ◽  
High Dose ◽  
Advanced Hodgkin’S Lymphoma ◽  
Grade Iii

Abstract Abstract 1754 Introduction: The development of the escalated BEACOPP regimen let to an improved outcome in patients with advanced Hodgkin‘s lymphoma (HD9 study of the GHSG). However, the application of high dose etoposide (cumulative 4,8 g/m2 per 8 cycles) seems to be associated with an increased incidence of secondary MDS and AML, respectively. Therefore, the aim of our multicenter pilot study was to evaluate the efficacy and toxicity of the etoposide-free as well as dose-intensified BACOPP-D protocol. Methods: From May 2000 until August 2008 a total of 139 untreated patients with Hodgkin‘s lymphoma (HL) stage IIB, III, and IV were treated with BACOPP-D which included cyclophosphamide 1250 mg/m2 (d1), adriamycin 25 mg/m2 (d1+2), dacarbazine 250 mg/m2 (d1-3), procarbazine 100 mg/m2 (d1-7), prednisolone 40 mg/m2 (d1-14), bleomycin 10 mg/m2 (d8) and vincristine 1,4 mg/m2 (maximum 2 mg, d8) at three-weekly intervals with granulocyte colony-stimulating factor (G-CSF). A consolidating involved field radiation (30 Gy) was performed only in patients who achieved less than CR following chemotherapy. Post-treatment follow-up included PET imaging. Results: All patients (median age 34 years, range 16–65; 86 male, 53 female) are assessable for toxicity and treatment outcome. We analyzed the acute toxicity for 1060 cycles of BACOPP-D. CTC grade III/IV haematological toxicities per patient were observed as follows: leukopenia 92%, anemia 40%, and thrombocytopenia 35%. CTC grade III/IV non-haematological side effects included documented infection (8%) and lung toxicity (one patient). Consolidation radiotherapy was given in 73 patients (52,5%). A total of 125 patients (89,9%) achieved complete remission, 9 patients (6,5%) achieved partial remission, five patients (3,6%) had progressive disease. At a median observation time of 46 months (5-109 months), 9 patients (6,5%) have relapsed, and 11 deaths were documented (4 HL-specific and 4 treatment related deaths, 1 death due to ruptured Meckel diverticulum with peritonitis, one 65 year-old woman died in CR following myocardial infarction and 1 death due to secondary malignancy). Only two patients developed a second neoplasia (hypopharyngeal carcinoma in an alcoholic; melanoma). The overall survival and progression free survival rates at 46 months were 89,7% and 85,9%, respectively. Discussion: BACOPP-D regimen appears as a feasible and effective treatment which induced a complete morphologic remission in a high proportion of patients with advanced HL. The treatment was associated with moderate acute toxicity. No secondary AML or MDS occurred so far. Disclosures: No relevant conflicts of interest to declare.

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