High-dose sequential chemotherapy versus a less intensive regimen followed by peripheral blood autologous hematopoietic stem cell transplantation as salvage treatment in relapsed and refractory Hodgkin’s disease

Background and Objective. High-dose sequential chemotherapy (HDS) has been given to patients with Hodgkin’s disease (HD) before autologous hematopoietic stem cell transplantation (HSCT), but its effectiveness has not been evaluated in comparison with less-aggressive regimens. In this study we compared HDS with a less-aggressive regimen as preparation to autologous HSCT in patients with HD. Design and Methods. Retrospective non-randomized comparison between patients receiving HDS (group 1, n=52) or a less-aggressive regimen (group 2, n=60). HDS consisted of the sequential administration of cyclophosphamide (7 g/m2) and G-CSF (300 mg/day) with stem cell collection, methotrexate (8 g/m2) plus vincristine (1.4 mg/m2), and etoposide (2 g/m2). Group 2 patients received of 2 cycles of DHAP, followed by cyclophosphamide (1.5 g/m2) plus G-CSF and stem cell collection. Results. Group 1 patients were more likely to have stage IV (40% vs. 13%, p=0.001) and bulky disease (62% vs. 39%, p=0.02) at diagnosis. Disease status after chemotherapy improved in 59% in group 1 and 8% in group 2 (p<0.001), mostly in patients with disease progression (DP): 50% in group 1 (4 CR and 12 PR) and none in group 2 (p<0.001). Treatment-related toxicity occurred in 5/32 patients with DP in group 1, and 0/28 patients in group 2 (p=0.01). Overall survival was 49% in group 1 and 59% in group 2 (p=0.098). Interpretation and Conclusions. HDS seems to be useful in patients with DP, whereas patients with CR do well with less-intensive chemotherapy.