DEXA-BEAM IN PATIENTS WITH HODGKINS-DISEASE REFRACTORY TO MULTIDRUG CHEMOTHERAPY REGIMENS - A TRIAL OF THE GERMAN HODGKINS-DISEASE STUDY-GROUP

被引:108
作者
PFREUNDSCHUH, MG
RUEFFER, U
LATHAN, B
SCHMITZ, N
BROSTEANU, O
HASENCLEVER, D
HAAS, R
KIRCHNER, H
KOCH, P
KUSE, R
LOEFFLER, M
DIEHL, V
机构
[1] UNIV KLIN KOLN, INNERE MED KLIN 1, HODGKIN STUDIENSEKRETARIAT, D-50924 COLOGNE, GERMANY
[2] MED KLIN & POLYKLIN SAARLANDES, HOMBURG, GERMANY
[3] CHRISTIAN ALBRECHTS UNIV KIEL, MED KLIN & POLYKLIN 2, KIEL, GERMANY
[4] UNIV HEIDELBERG, MED KLIN & POLYKLIN, HEIDELBERG, GERMANY
[5] HANNOVER MED SCH, HANNOVER, GERMANY
[6] UNIV KLIN MUNSTER, MED KLIN A, MUNSTER, GERMANY
[7] ALLGEMEINES KRANKENHAUS ST GEORG, HAMBURG, GERMANY
关键词
D O I
10.1200/JCO.1994.12.3.580
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: A prospective phase II study was conducted to evaluate the efficacy of dexamethasone, carmustine, etoposide, cytarabine, and melphalan (Dexa-BEAM) as salvage chemotherapy for patients with Hodgkin's disease. Patients and Methods: Fifty-five patients progressing on or relapsing after eight- or 10-drug chemotherapy (cyclophosphamide, vincristine, procarbazine, and prednisone plus doxorubicin, bleomycin, vinblastine, and dacarbazine [COPP + ABVD] or COPP + ABV + ifosfamide, methotrexate, etoposide, and prednisone [IMEP]) were treated with Dexa-BEAM. Patients who responded after two cycles of Dexa-BEAM either continued treatment for another two to three cycles or received high-dose chemotherapy/autologous bone marrow transplantation (HDCT/ABMT) with cyclophosphamide, etoposide, and carmustine (BCNU) (CVB) as conditioning regimen. Results: Seventeen patients (31%) achieved a complete remission and 16 (29%) a partial remission, resulting in a response rate of 60% (95% confidence interval, 46% to 73%). Progressive disease developed in 18 patients. Toxicity of Dexa-BEAM was acceptable with pronounced, but temporary World Health Organization (WHO) grade III/IV granulocytopenia and thrombocytopenia occurring in more than 90% of all courses. Two patients died of sepsis during granulocytopenia. Three prognostic subgroups could be distinguished: (1) patients progressing on initial chemotherapy, (2) patients relapsing within 12 months, and (3) patients with fate relapses. The response rates for these groups were 52%, 60%, and 83%, and the median survival duration 12, 29, and 40+ months, respectively. In a nonrandomized comparison, the survival of patients who responded to two cycles of Dexa-BEAM and had additional cycles of Dexa-BEAM (n = 14) was not different from those responding patients who underwent HDCT/ABMT (n = .19). However, the power to detect a 20% survival difference was only 33% in this comparison. Conclusion: Dexa-BEAM is an effective salvage treatment for patients with Hodgkin's disease who fail to respond to multidrug chemotherapy. Efficacy and toxicity are comparable to HDCT/ABMT and underline the need for prospective randomized trials to define better the role of HDCT with and without ABMT in these patients.
引用
收藏
页码:580 / 586
页数:7
相关论文
共 38 条
[1]   ALTERNATING NON-CROSS-RESISTANT COMBINATION CHEMOTHERAPY OR MOPP IN STAGE-IV HODGKINS-DISEASE - A REPORT OF 8-YEAR RESULTS [J].
BONADONNA, G ;
VALAGUSSA, P ;
SANTORO, A .
ANNALS OF INTERNAL MEDICINE, 1986, 104 (06) :739-746
[2]  
CANELLOS GP, 1983, SEMIN HEMATOL, V20, P1
[3]   THE 2ND CHANCE FOR ADVANCED HODGKINS-DISEASE [J].
CANELLOS, GP .
JOURNAL OF CLINICAL ONCOLOGY, 1992, 10 (02) :175-177
[4]   HIGH-DOSE CHEMOTHERAPY WITH AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN 50 ADVANCED RESISTANT HODGKINS-DISEASE PATIENTS - AN ITALIAN STUDY-GROUP REPORT [J].
CARELLA, AM ;
CONGIU, AM ;
GAOZZA, E ;
MAZZA, P ;
RICCI, P ;
VISANI, G ;
MELONI, G ;
CIMINO, G ;
MANGONI, L ;
COSER, P ;
CETTO, GL ;
CIMINO, R ;
ALESSANDRINO, EP ;
BRUSAMOLINO, E ;
SANTINI, G ;
TURA, S ;
MANDELLI, F ;
RIZZOLI, V ;
BERNASCONI, C ;
MARMONT, AM .
JOURNAL OF CLINICAL ONCOLOGY, 1988, 6 (09) :1411-1416
[5]  
CERVANTES F, 1986, CANCER TREAT REP, V70, P665
[6]   THE OPTIMAL TIMING OF AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN HODGKINS-DISEASE PATIENTS AFTER A CHEMOTHERAPY RELAPSE [J].
DESCH, CE ;
LASALA, MR ;
SMITH, TJ ;
HILLNER, BE .
JOURNAL OF CLINICAL ONCOLOGY, 1992, 10 (02) :200-209
[7]   COMBINATION CHEMOTHERAPY IN TREATMENT OF ADVANCED HODGKINS DISEASE [J].
DEVITA, VT ;
SERPICK, AA ;
CARBONE, PP .
ANNALS OF INTERNAL MEDICINE, 1970, 73 (06) :881-+
[8]   METHYL-GAG, IFOSFAMIDE, METHOTREXATE AND ETOPOSIDE (MIME) AS SALVAGE THERAPY FOR HODGKINS-DISEASE AND NON-HODGKINS-LYMPHOMA [J].
ENBLAD, G ;
GLIMELIUS, B ;
HAGBERG, H ;
LINDEMALM, C .
ACTA ONCOLOGICA, 1990, 29 (03) :297-301
[9]   PROLONGED DISEASE-FREE SURVIVAL IN HODGKINS-DISEASE WITH MOPP REINDUCTION AFTER 1ST RELAPSE [J].
FISHER, RI ;
DEVITA, VT ;
HUBBARD, SP ;
SIMON, R ;
YOUNG, RC .
ANNALS OF INTERNAL MEDICINE, 1979, 90 (05) :761-763
[10]  
GRIBBEN JG, 1987, HEMATOL ONCOL, V5, P281