High-dose salvage chemotherapy without bone marrow transplantation for adult patients with refractory Hodgkin's disease.

Tourani, J.M.; Lévy, R.; Colonna, P; Desablens, B; Leprise, P. Y.; Guilhot, Joëlle; Brahimi, S; Belhani, M; Ifrah, Norbert; Sensebé, Luc

doi:10.1200/jco.1992.10.7.1086

Cited by 40 publications

(10 citation statements)

References 30 publications

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“…8 Conversely, when patients relapse less than 12 months after their first CR or when they do not achieve a first CR, the results of conventional salvage therapy are worse and few long-term survivors are expected. 7,8,[11][12][13][14] High-dose chemotherapy followed by autologous hematopoietic rescue was considered a viable option because of good results achieved in a series of phase II trials. In refractory patients pooled with complete responders (Ͻ12 months), high-dose chemotherapy with reinfusion of HSC yielded CR rates of 40-80% with approximately 40% of patients free of disease at 3 years.…”

Section: Discussionmentioning

confidence: 99%

VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refractory Hodgkin’s disease

Ribrag

Nasr

Bouhris

et al. 1998

Bone Marrow Transplant

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Summary:Forty-two patients with refractory (15 patients) or relapsed (27 patients) Hodgkin's disease (HD) were included in a prospective single center study evaluating the efficacy of a regimen VIP combining etoposide 75 mg/m 2 /day days 1-5, ifosfamide 1.2 g/m 2 /day days 1-5 and cisplatinum 20 mg/m 2 /day days 1-5, one course every 4 weeks as salvage therapy in patients with refractory or relapsed Hodgkin's disease, potentially eligible for high-dose chemotherapy with reinjection of hematopoietic stem cells (HSC). If patients were considered chemosensitive after two courses of VIP, high-dose chemotherapy followed by the reinjection of HSC was planned. After two courses of VIP, 67% achieved an objective response including 38% complete responses. Overall, 28 patients went on to high-dose therapy with reinjection of HSC, and 46% of grafted patients are in a sustained complete remission. When the overall patient population is considered, 33% are in complete remission (CR) with a median follow-up of 37 months. A CR of less than 12 months and refractory disease were associated with a poor survival. These results showed that the VIP regimen is effective in relapsed or refractory HD and allows high-dose therapy to be given in the case of most responding patients. However, results in patients with refractory disease or a first complete remission of less than 12 months need to be further improved. Keywords: Hodgkin's disease; salvage therapy; VIP; etoposide; ifosfamide; cisplatinumThe prognosis for patients with Hodgkin's disease (HD) has dramatically improved with the use of modern extended-field radiotherapy and/or chemotherapy. With first-line chemotherapy, up to 80% of patients with advanced Hodgkin's disease achieve a complete remission (CR). 1-5 Despite optimal initial treatment, 20-50% of patients fail to enter remission or will relapse after achieving a complete response. [1][2][3][4][5][6][7] It has long been stated that patients who relapse after a first remission can be divided into two groups according to the length of their first remission. When patients relapse more than 1 year after the end of their first-line therapy, as many as 85% of them achieve a second complete remission when the same drug combination is used. 8-10 However, recent reports have shown that long-term disease-free survival at 15 years is achieved in only 20% of these favorable relapses. 8 Conversely, when patients relapse less than 12 months after their first CR or when they do not achieve a first CR, the results of conventional salvage therapy are worse and few long-term survivors are expected. 7,8,[11][12][13][14] High-dose chemotherapy followed by autologous hematopoietic rescue was considered a viable option because of good results achieved in a series of phase II trials. In refractory patients pooled with complete responders (Ͻ12 months), high-dose chemotherapy with reinfusion of HSC yielded CR rates of 40-80% with approximately 40% of patients free of disease at 3 years. [15][16][17][18][19][20][21][22][23][24][25] High-dose chemo...

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Section: Discussionmentioning

confidence: 99%

VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refractory Hodgkin’s disease

Ribrag

Nasr

Bouhris

et al. 1998

Bone Marrow Transplant

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“…All patients had previously received four to eight CHOP regimen with or without rituximab (four to eight infusions of 375 mg/m 2 /day). One rHuEpo recipient suffering from bulky mediastinal Hodgkin's disease was treated with three VABEMP cycles 11 and local radiotherapy; an early mediastinal relapse was treated with six cycles of GNC (gemcitabine 1 g/m 2 , vinorelbine 30 mg/m 2 and cisplatin 40 mg/m 2 every other week) before HDT with BEAM.…”

Section: Patients and Historical Controlsmentioning

confidence: 99%

rHuEpo before high-dose therapy allows autologous peripheral stem-cell transplantation without red blood cell transfusion: a pilot study

Hunault¹,

Tanguy‐Schmidt²,

Rachieru³

et al. 2005

Bone Marrow Transplant

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Summary:To decrease red blood cell (RBC) transfusion requirements during high-dose therapy (HDT) for hematological malignancies, we conducted a pilot study to assess the effect of recombinant human erythropoietin (rHuEpo) given during chemotherapy before HDT and autologous peripheral stem-cell transplantation (APSCT). The transfusion histories of 15 HDT and APSCT for hematological disease performed in 11 consecutive patients who received rHuEpo (10 000 U subcutaneously three times/week) were compared to those of 22 HDT and ASCT performed in 17 consecutive historical controls matched for hematological parameters. rHuEpo increased the hemoglobin (Hb) level from 10.372.3 g/dl at diagnosis to 12.972.2 g/dl at the time of HDT in 11 patients; no major adverse effects occurred. Compared to historical controls (95%, 21/22), RBC transfusion requirements were significantly lower for rHuEpo recipients (26%, 4/15) (P ¼ 0.00001) and rHuEpo responders (15%, 2/13) (P ¼ 0.000002). After HDT and APSCT, fewer RBC transfusions were needed: 3.3, 1.2 and 0.3 RBC units for controls, rHuEpo recipients and rHuEpo responders, respectively (P ¼ 0.006 and 0.00002). Therefore, rHuEpo should be administered before, and not after HDT and APSCT, to lower RBC transfusion requirements after HDT and APSCT. Bone Marrow Transplantation (2005) 35, 903-907.

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“…Alternatively, hematopoietic growth factors andlor primed PBSC infusions could be used to allow multiple courses of moderately intensive chemotherapy-that is, therapy more myelosuppressive than primary chemotherapy, but of less intensity than a pre-transplant conditioning regimen such as CBV. Repetitive courses of salvage chemotherapy of moderate intensity without specific methods to reduce hematologic toxicity have been reported in HD [54-561, and two series have yielded results similar to those seen after conditioning therapy and autologous transplantation [54,56]. The addition of growth factors or stem cells to such an approach is appealing and is undergoing evaluation in other malignancies, although it has not yet been widely explored in HD.…”

Section: Hematologic Toxicitymentioning

confidence: 99%

Intensive therapy and autotransplantation in hodgkin's disease

Reece

Phillips

1994

STEM CELLS

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Intensive therapy and autologous marrow or peripheral blood stem cell transplantation is often utilized in Hodgkin's disease patients whose disease has progressed after primary conventional chemotherapy. A number of studies have described long-term disease-free survival in up to 50% of transplanted patients. High-dose chemotherapy conditioning regimens such as "CBV" or "BEAM" have been used more often than regimens containing total body irradiation. Usually unpurged autologous bone marrow has been utilized as the source of hematopoietic stem cell reconstitution, although recently the use of "primed" peripheral blood stem cells has increased markedly. The challenges of transplant-related toxicity and recurrence of disease post-transplant are discussed, as well as possible strategies to reduce these problems. The use of autologous transplantation is discussed in three clinical settings: patients who have failed to enter a complete remission (CR) after primary chemotherapy, those who have relapsed within 12 months of attaining a CR and those who have relapsed after a longer (i.e., > or = 12 months) first CR. When compared with conventional salvage chemotherapy, transplantation appears to produce a higher long-term disease-free survival rate in all of these patient groups. However, assessment of an advantage for autotransplantation, particularly in patients with long first remissions, is difficult without a Phase III trial. On the other hand, recently updated results from our center indicate that 72% of patients relapsing after long initial remissions benefit from autotransplantation at this point in their disease course, and that transplant-related mortality is low in this setting. Other issues addressed include the potential role of autologous transplantation as consolidation therapy in selected high-risk patients in an initial CR, as well as the utility of conventional chemotherapy and involved-field radiotherapy in conjunction with autotransplantation.

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High-dose salvage chemotherapy without bone marrow transplantation for adult patients with refractory Hodgkin's disease.

Abstract: The results of this study seem to be comparable to those results obtained with high-dose chemotherapies with autologous BMT.

Cited by 40 publications

References 30 publications

VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refractory Hodgkin’s disease

VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refractory Hodgkin’s disease

rHuEpo before high-dose therapy allows autologous peripheral stem-cell transplantation without red blood cell transfusion: a pilot study

Intensive therapy and autotransplantation in hodgkin's disease

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