Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial

Schmitz, Norbert; Pfistner, Beate; Sextro, M; Sieber, M.; Carella, Angelo Michele; Haenel, Matthias W.; Boissevain, F.; Zschaber, R.; Müller, Peter E.; Kirchner, Hartmut; Lohri, Andreas; Decker, Susanne; Koch, Bettina; Hasenclever, Dirk; Goldstone, Anthony H.; Diehl, Volker

doi:10.1016/s0140-6736(02)08938-9

Cited by 1,040 publications

(771 citation statements)

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“…However, 2-5% and 5-10% of patients have a primary refractory disease, and 10-15% and 25-30% of patients experience relapse after conventional chemotherapy in early-stage HL and advanced-stage HL, respectively [1,2]. For these patients, several studies have demonstrated that autologous hematopoietic stem cell transplantation (HSCT) can prolong survival [3][4][5]. In a randomized trial, Schmitz et al reported longer time to treatment failure in patients with chemosensitive relapsed HL who underwent autologous HSCT, compared to those who underwent only conventional chemotherapy [5].…”

Section: Introductionmentioning

confidence: 99%

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

et al. 2014

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on behalf of the Adult Lymphoma Working Group of the Japanese Society for Hematopoietic Cell TransplantationThe optimal treatment strategy with the use of hematopoietic stem cell transplantation (HSCT) for relapsed and refractory Hodgkin lymphoma (HL) remains unclear. We performed a retrospective analysis using registry data from the Japanese Society for Hematopoietic Cell Transplantation. Adult patients with HL who underwent a first autologous or a first allogeneic HSCT between 2002 and 2009 were included. Patients who underwent HSCT in first complete remission (CR) were excluded. Autologous and allogeneic HSCT were performed in 298 and 122 patients, respectively. For autologous HSCT, overall survival at 3 years (3yOS) was 70%, and sex, age, disease status, and performance status (PS) at HSCT were prognostic factors. OS was favorable even in patients who underwent autologous HSCT in disease status other than CR. For allogeneic HSCT, 3yOS was 43%, and sex and PS at HSCT were prognostic factors. Disease status at HSCT, previous autologous HSCT, and conditioning intensity did not affect OS. Moreover, graft-versus-host disease did not affect progression-free survival or relapse/progression rate. A first allogeneic HSCT without a previous autologous HSCT was performed in 40 patients. 3yOS was 45%, and was significantly inferior to that in patients who underwent their first autologous HSCT. This result was retained after the correction by the different patient characteristics according to the type of HSCT. In conclusion, autologous HSCT is effective in prolonging survival in patients with relapsed and refractory HL. Allogeneic HSCT might be beneficial even to relapsed HL after autologous HSCT, although establishing the role of allogeneic HSCT remains a challenge.

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Section: Introductionmentioning

confidence: 99%

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

et al. 2014

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“…Despite these improvements in treatment, approximately 50% of patients with advanced disease will relapse or fail treatment with first line chemotherapy (Fisher et al, 1994;Canellos and Niedzwiecki, 2002;Coiffier et al, 2002). However, salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant (ASCT) in patients with chemo-sensitive HL and aggressive NHL can lead to long-term remission in 46 -55% of patients (Linch et al, 1993;Philip et al, 1995;Schmitz et al, 2002).…”

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confidence: 99%

Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma

Waters

Cunningham

et al. 2005

Br J Cancer

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There is currently no standard salvage chemotherapy regimen in relapsed and refractory lymphoma. Gemcitabine is a novel nucleoside analogue, which acts synergistically with cisplatin both in vitro and in clinical studies. We evaluated the combination of gemcitabine, cisplatin and methylprednisolone (GEM-P) in 41 heavily pretreated patients with relapsed and refractory Hodgkin's and non-Hodgkin's lymphoma. The best-achieved response rate (RR) was 79% (95% CI 64 -91), with a complete RR of 21%. In patients with chemo-resistant disease, the RR was 63%. Myelosuppression was the main toxicity, the incidence of Grade 3 or 4 anaemia, neutropenia and thrombocytopenia was 17.1, 61.0 and 53.7% respectively. Only one patient had neutropenic sepsis and none of the patients suffered from haemorrhage. Grade 3 or 4 nonhaematological toxicity was minimal and stem cell mobilisation was not inhibited. GEM-P is an effective salvage regimen and its use prior to autologous stem cell transplant warrants further investigation.

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“…Indeed, several nonrandomized studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] have suggested a better outcome for patients receiving HDCT. These results have been confirmed by two randomized studies [18,19] comparing a single course of HDCT to conventional chemotherapy in chemo-sensitive patients.…”

Section: Introductionmentioning

confidence: 63%

“…Three-year overall survival for all patients. as the reference conditioning regimen for HL patients with a low TRM [18,19]. With this protocol, in chemo-sensitive HL patients, the progressionfree survival and OS rates range between 50% and 69% and between 51% and 77%, respectively [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…At present, treatment-related mortality (TRM) after a single HDCT course is less than 5% [19]. As a consequence, and considering that most patients with HL are young and would be expected to tolerate treatment well, we assume two courses of HDCT (tandem HDCT) with autologous stem cell support, following a debulking phase with highly effective chemotherapy, are feasible.…”

Section: Introductionmentioning

confidence: 99%

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Tandem high‐dose chemotherapy and autologous stem cell transplantation in refractory/relapsed Hodgkin's lymphoma: A monocenter prospective study

et al. 2006

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We designed a prospective study to evaluate the feasibility and efficacy of tandem highdose chemotherapy (HDCT) in the treatment of refractory or relapsed Hodgkin's lymphoma (HL). Thirty-two patients were treated with salvage chemotherapy (IGEV, ifosfamide, gemcitabine, and vinorelbine) and chemo-sensitive patients received a first HDCT course with melphalan 200 mg/m 2 (MEL200) and a second BEAM course. The median time interval between the two HDCT courses was 66 days. The median number of reinfused CD34 + cells was 4.7 x 10 6 /kg after MEL200 and 5.8 x 10 6 /kg after BEAM. The hematological reconstitution after both HDCT courses did not differ. No grade III or IV renal, hepatic, lung, cardiac, and neurological toxicity was observed. Severe (grade III and IV) oral mucositis was the most prominent complication affecting 60 and 50% of patients after MEL200 and BEAM, respectively. Fever of unknown origin occurred in 65 and 70% of patients after MEL200 and BEAM, respectively. One patient died from septic shock during the aplasia period following BEAM. In an intention-to-treat analysis, the overall response rate increased after each stage of protocol, ranging from 47% to 65% and 75% after IGEV, MEL200, and BEAM, respectively. Tandem HDCT is feasible and effective in patients with relapsed or refractory HL. Am. J. Hematol. 82:122-127, 2007. V V C 2006 Wiley-Liss, Inc.

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Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial

Cited by 1,040 publications

References 28 publications

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma

Tandem high‐dose chemotherapy and autologous stem cell transplantation in refractory/relapsed Hodgkin's lymphoma: A monocenter prospective study

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