Single and double autotransplants for relapsing/refractory Hodgkin's disease: Results of two consecutive trials

To evaluate a strategy of one cycle of dose-intensive chemotherapy for patients with Hodgkin's disease in sensitive relapse and two cycles for those with refractory disease, 122 patients received dose-intensive chemotherapy followed by autotransplant in two consecutive studies, Patients with refractory disease were offered a second transplant with different conditioning in the absence of progression or excessive toxicity, CR was present after treatment in 46% while 16% died in the peritransplant period, Of 41 patients with primary refractory disease and 42 with refractory relapse, 24 and 21 respectively received a second cycle, Of these 45 refractory patients, 12 were in CR and 11 in PR after the first cycle and 10 of these 11 in PR achieved a durable CR with the second transplant, The CR rate is 37% in patients with refractory relapse and 19% in those with primary refractory disease, At a median follow-up of 4 years, median survival is 45 months, Progression-free survival of the refractory patients who could receive a second cycle was similar to that of patients with sensitive disease, A sequential transplant strategy is feasible, A subgroup of patients with refractory disease can achieve long-term survival after sequential BMT.