Phase I/II trial of total lymphoid irradiation and high-dose chemotherapy with autologous stem-cell transplantation for relapsed and refractory Hodgkin's lymphoma

A. M. Evens, J. K. Altman, B. B. Mittal, N. Hou, A. Rademaker, D. Patton, L. Kaminer, S. Williams, S. Duffey, D. Variakojis, S. Singhal, M. S. Tallman, J. Mehta, J. N. Winter, L. I. Gordon*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Background: The standard approach to treatment of relapsed/refractory Hodgkin's lymphoma (HL) is high-dose chemotherapy conditioning followed by autologous hematopoietic stem-cell transplantation (aHSCT). We report the results of a prospective phase I/II clinical trial of accelerated hyperfractionated total lymphoid irradiation (TLI) immediately followed by high-dose chemotherapy for relapsed/refractory HL. Patients and methods: Forty-eight patients underwent aHSCT with either sequential TLI/chemotherapy (n = 32) or chemotherapy-alone conditioning (n = 16), based on prior radiation exposure. The first 22 patients enrolled on trial received escalating doses of etoposide (1600-2100 mg/m 2) with high-dose carboplatin and cyclophosphamide. Results: No dose-limiting toxicity was seen and TLI/chemotherapy was well tolerated. The 5-year event-free survival (EFS) estimate for all patients was 44% with overall survival (OS) of 48%. Five-year EFS and OS for the TLI/chemotherapy group was 63% and 61%, respectively, compared with 6% and 27%, respectively, for the chemotherapy-alone group (P < 0.0001 and P = 0.04, respectively). Patients with primary induction failure HL who received TLI/chemotherapy had 5-year EFS and OS rate of 83%. The 100-day treatment-related mortality was 4.2% and two secondary cancers were seen. Significant factors predicting survival by multivariate analysis included TLI/chemotherapy conditioning and B symptoms at relapse. Conclusions: Sequential TLI/chemotherapy conditioning for relapsed/ refractory HL is safe and associated with excellent long-term survival rates.

Original languageEnglish (US)
Pages (from-to)679-688
Number of pages10
JournalAnnals of Oncology
Volume18
Issue number4
DOIs
StatePublished - Apr 2007

Keywords

  • Autologous transplantation
  • Hodgkin's lymphoma
  • Outcomes
  • Prognosis
  • Therapy
  • total lymphoid irradiation

ASJC Scopus subject areas

  • Hematology
  • Oncology

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