[Autologous stem cell transplantation in patients with relapsed or refractory Hodgkin's disease]

Patients with relapsed or refractory Hodgkin's disease (HD) are routinely treated with intensive chemotherapy followed by autologous stem cell transplantation (ASCT). The objectives of the study were to evaluate ASCT in this subset of patients by assessing its toxicity in terms of transplant related mortality (TRM), hematopoietic recovery and need for transfusion support, and efficacy in terms of complete remission (CR) achieved as well as long-term efficacy expressed in patient overall survival (OS). From February 1995 until October 2006, a total of 53 patients with active HD (28 male and 25 female, aged 18-60, median 29) received BEAM myeloablative treatment followed by ASCT. All patients received heavy prior treatment with a median of 2 different lines of chemotherapy (range 1-6) and a median of 8 chemotherapeutic cycles (range 2-15). A mean of 9.12 (range 1.03-32.6, SD 9.5) x 10(6)/kg CD34+ cells was reinfused, followed by filgrastim (median 8 days, range 4-22 days). The median time to WBC recovery (> 1 x 10(9)/L) was 10 (range 2-26) days, while platelets recovered (> 20 x 10(9)/L) in a median of 10 (range 4-30) days. During the post-transplant period, a mean of 16.3 platelet doses (range 0-77, SD 15.5) and 345.6 mL of RBC concentrate (range 0-1990, SD 478.4) was administered. A median of 3 febrile days (range 0-20) was observed. Of all patients, 43 (81.1%) achieved CR and 9 (17.0%) achieved partial remission. One patient died during the pancytopenic period (TRM 1.9%). The projected overall survival is 66.3% at 3948 days. Accordingly, in this group of patients with active disease at the time of transplantation, ASCT toxicity could be considered acceptable. A very high remission rate was achieved (CR+PR 98.1%). We conclude that BEAM myeloablative chemotherapy followed by ASCT is a very efficacious treatment for patients with relapsed or refractory HD.