[High dose chemoradiotherapy with autologous hemotopoietic stem cell transplantation for treatment of patients with advanced Hodgkin's lymphoma: a report of 11 cases].

BACKGROUND &

OBJECTIVES

High dose chemoradiotherapy (HDT) with autologous hemotopoietic stem cell transplantation (ASCT) has become one of the important salvaged treatments for the Hodgkin's Lymphoma(HL) patients with relapsed or resistant disease, but its role as the primary treatment remains indefinite. This study was designed to further evaluate its status in the combined modality treatment, especially, to discuss its value in the primary treatment of the patients with advanced disease and poor prognosis.

METHODS

Eleven patients who had advanced or relapsed disease with poor prognosis were enrolled in this study. Among them, 9 patients were primary treatment, and 2 patients were secondary treatment. One patient received autologous bone marrow transplantation (ABMT), and 10 patients received autologous peripheral blood stem cell transplantation (APBSCT). After induction treatment 4 cases achieved complete response (CR) and 7 cases achieved partial response (PR). High dose chemotherapy combined with total body irradiation (TBI) or total lymph node irradiation(TLI)/subtotal lymph node irradiation(STLI) were applied in 7 cases and high dose chemotherapy alone was used in 4 cases as preparative treatment before transplantion. Five cases received complementary irradiation in the primary sites after transplant.

RESULTS

These cases who had been CR before transplantation were consolidative therapy, and among the rest with PR, 2 cases achieved CR, 1 cases PR, and 4 cases stable disease(SD). Furthermore all these patients who maintained SD had bone involvement. With a median follow-up of 13(1-84) months for all patients, all of them were alive at that time. Four cases were event-free survival (EFS); Four cases with bone involvement are progression-free survival (PFS). Three cases experienced relapse after transplant, one of them was EFS for 42 months again after a local relapsed site irradiation; the other two cases were being given further salvaged treatment now. According to the life tables method, the cumulative probability of 6-year PFS and OS was 55.68% and 100%, respectively. The major transplant-related toxicity was bone marrow suppression of grades IV. No obvious cardiac, hepatic, and nephritic toxicity was found, neither transplant relative mortality.

CONCLUSIONS

HDT combined with ASCT is a method that worth to be further study to treat the patients with advanced or relapsed Hodgkin's Lymphoma with poor prognosis.