1. ¹Department of Oncology, King Faisal Cancer Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
2. ²Centre Hospitalier Public du Cotentin, Service d'Oncologie, Cherbourg-Octeville, France
3. ³Department of Oncology, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia

Correspondence: Dr S Akhtar, Department of Oncology, King Faisal Cancer Center, King Faisal Specialist Hospital and Research Center, PO Box 3354, MBC # 64, Riyadh 11211, Kingdom of Saudi Arabia. E-mails: sakhtar@kfshrc.edu.sa, akhtars18@hotmail.com

Received 8 January 2007; Revised 29 May 2007; Accepted 14 June 2007; Published online 30 July 2007.

Abstract

We report our experience with high-dose chemotherapy (HDC) and autologous SCT (ASCT) in 66 patients with primary refractory Hodgkin's lymphoma (PR-HL) who received salvage chemotherapy followed by BEAM as HDC. Median age at ASCT was 23 years. Before salvage chemotherapy, stages I:II:III:IV were 2:21:14:29, bulky disease 27%, involvement of mediastinum 79%, spleen 26% and extranodal site 47%, 92% had ESHAP as salvage. Post-ASCT evaluation showed response in 50 patients (76%); complete response (CR) 37 (56%), partial response 14 (21%), no response or stable disease 3 (5%) and progressive disease in 10 (15%). Another five patients achieved CR after radiation therapy and one after surgery, making total CR 43 (65%). From diagnosis and HDC, median follow-up is 38.5 and 22.8 months and median overall survival (OS) 78 and 57 months, respectively. Event-free survival (EFS) and OS are 36 and 64%, respectively. In all, 47% patients are in CR. Twenty-two patients (33%) died due to disease. Multivariate analysis showed elevated lactate dehydrogenase (LDH) for EFS (P=0.041) and mediastinal involvement for OS (P=0.038) as negative prognostic factors. In conclusion, EFS and OS are only 36 and 64%, respectively. Elevated LDH and mediastinal involvement are poor prognostic factors.