Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Autografting

Autologous stem cell transplantation followed by consolidation chemotherapy for relapsed or refractory Hodgkin's lymphoma

Bone Marrow Transplantation volume 34, pages 883–890 (2004)Cite this article

Summary:

Relapse remains a major cause of treatment failure after autotransplantation (auto-PBSCT) for Hodgkin's disease (HD). The administration of non-crossresistant therapies during the post-transplant period may delay or prevent relapse. We prospectively studied the role of consolidation chemotherapy (CC) after auto-PBSCT in 37 patients with relapsed or refractory HD. Patients received high-dose gemcitabine–BCNU–melphalan and auto-PBSCT followed by involved-field radiation and up to four cycles of the DCEP-G regimen, which consisted of dexamethasone, cyclophosphamide, etoposide, cisplatin, gemcitabine given at 3 and 9 months post transplant alternating with a second regimen (DPP) of dexamethasone, cisplatin, paclitaxel at 6 and 12 months post transplant. The probabilities of event-free survival (EFS) and overall survival (OS) at 2.5 years were 59% (95% CI=42–76%) and 86% (95% CI=71–99%), respectively. In all, 17 patients received 54 courses of CC and 15 were surviving event free (2.5 years, EFS=87%). There were no treatment-related deaths during or after the CC phase. Post-transplant CC is feasible and well tolerated. The impact of this approach on EFS should be evaluated in a larger, randomized study.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Connors JM . Treatment of refractory or relapsed Hodgkin's lymphoma. Am Soc Hematol Educ Program Book 2003, 238–247.

  2. Yuen AR, Rosenberg SA, Hoppe RT et al. Comparison between conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory Hodgkin's disease. Blood 1997; 89: 814–822.

    CAS  PubMed  Google Scholar 

  3. Kessinger A, Bierman PJ, Vose JM, Armitage JO . High-dose cyclophosphamide, carmustine, and etoposide followed by autologous peripheral stem cell transplantation for patients with relapsed Hodgkin's disease. Blood 1991; 77: 2322–2325.

    CAS  PubMed  Google Scholar 

  4. Linch DC, Winfield D, Goldstone AH et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomized trial. Lancet 1993; 341: 1051–1054.

    Article  CAS  PubMed  Google Scholar 

  5. Majolino I, Pearce R, Taghipour G, Goldstone AH . Peripheral-blood-stem-cell transplantation versus autologous bone marrow transplantation in Hodgkin's and non-Hodgkin's lymphomas: a new matched-pair analysis of the European Group for Blood and Marrow Transplantation Registry Data. Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 1997; 15: 509–517.

    Article  CAS  PubMed  Google Scholar 

  6. Ager S, Mahendra P, Richards EM et al. High-dose carmustine, etoposide and melphalan (‘BEM’) with autologous stem cell transplantation: a dose-toxicity study. Bone Marrow Transplant 1996; 17: 335–340.

    CAS  PubMed  Google Scholar 

  7. Schmitz N, Pfistner B, Sextro M et al. German Hodgkin's Lymphoma Study Group. Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Lancet 2002; 359: 2065–2071.

    Article  CAS  PubMed  Google Scholar 

  8. Goldstone AH, McMillan AK . The place of high-dose therapy with haemopoietic stem cell transplantation in relapsed and refractory Hodgkin's disease. Ann Oncol 1993; 4: 21–27.

    Article  PubMed  Google Scholar 

  9. Stewart DA, Guo D, Sutherland JA et al. Single-agent high-dose melphalan salvage therapy for Hodgkin's disease: cost, safety, and long-term efficacy. Ann Oncol 1997; 8: 1277–1279.

    Article  CAS  PubMed  Google Scholar 

  10. Sureda A, Arranz R, Iriondo A et al. Grupo Espanol de Linformas/Transplante Autologo de Medula Osea Spanish Cooperative Group. Autologous stem-cell transplantation for Hodgkin's disease: results and prognostic factors in 494 patients from the Grupo Espanol de Linfomas/Transplante Auto logo de Medula Osea Spanish Cooperative Group. J Clin Oncol 2001; 19: 1395–1404.

    Article  CAS  PubMed  Google Scholar 

  11. Lancet JE, Rapoport AP, Brasacchio R et al. Autotransplantation for relapsed or refractory Hodgkin's disease: long-term follow-up and analysis of prognostic factors. Bone Marrow Transplant 1998; 22: 265–271.

    Article  CAS  PubMed  Google Scholar 

  12. Lazarus HM, Loberiza Jr FR, Zhang MJ et al. Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR). Bone Marrow Transplant 2001; 4: 387–396.

    Article  Google Scholar 

  13. Tarella C, Cuttica A, Vitolo U et al. High-dose sequential chemotherapy and peripheral blood progenitor cell autografting in patients with refractory and/or recurrent Hodgkin lymphoma: a multicenter study of the intergruppo Italiano Linfomi showing prolonged disease free survival in patients treated at first recurrence. Cancer 2003; 97: 2748–2759.

    Article  CAS  PubMed  Google Scholar 

  14. Ferme C, Mounier N, Divine M et al. Intensive salvage therapy with high-dose chemotherapy for patients with advanced Hodgkin's disease in relapse or failure after initial chemotherapy: results of the Groupe d'Etudes des Lymphomes de l'Adulte H89 trial. J Clin Oncol 2002; 20: 467–475.

    CAS  PubMed  Google Scholar 

  15. Sweetenham JW, Carella AM, Taghipour G et al. High-dose therapy and autologous stem-cell transplantation for adult patients with Hodgkin's disease who do not enter remission after induction chemotherapy: results in 175 patients reported to the European Group for Blood and Marrow Transplantation. Lymphoma Working Party. J Clin Oncol 1999; 17: 3101–3109.

    Article  CAS  PubMed  Google Scholar 

  16. Lazarus HM, Rowlings PA, Zhang MJ et al. Autotransplants for Hodgkin's disease in patients never achieving remission: a report from the Autologous Blood and Marrow Transplant Registry. J Clin Oncol 1999; 17: 534–545.

    Article  CAS  PubMed  Google Scholar 

  17. Korbling M, Holle R, Haas R et al. Autologous blood stem-cell transplantation in patients with advanced Hodgkin's disease and prior radiation to the pelvic site. J Clin Oncol 1990; 8: 978–985.

    Article  CAS  PubMed  Google Scholar 

  18. Schmitz N, Linch DC, Dreger P et al. Randomized trial of filgrastim-mobilized peripheral blood progenitor cell transplantation versus autologous bone-marrow transplantation in lymphoma patients. Lancet 1996; 347: 353–357.

    Article  CAS  PubMed  Google Scholar 

  19. Smith TJ, Hillner BE, Schmitz N et al. Economic analysis of a randomized clinical trial to compare filgrastim-mobilized peripheral-blood progenitor-cell transplantation and autologous bone marrow transplantation in patients with Hodgkin's and non-Hodgkin's lymphoma. J Clin Oncol 1997; 15: 5–10.

    Article  CAS  PubMed  Google Scholar 

  20. Constans M, Sureda A, Terol MJ et al. GEL/TAMO Cooperative Group. Autologous stem cell transplantation for primary refractory Hodgkin's disease: results and clinical variable affecting outcome. Ann Oncol 2003; 14: 745–751.

    Article  CAS  PubMed  Google Scholar 

  21. Reece DE, Phillips GL . Intensive therapy and autotransplantation in Hodgkin's disease. Stem Cells 1994; 12: 477–493.

    Article  CAS  PubMed  Google Scholar 

  22. Josting A, Reiser M, Rueffer U et al. Treatment of primary progressive Hodgkin's and aggressive non-Hodgkin's lymphoma: is there a chance for cure? J Clin Oncol 2000; 18: 332–339.

    Article  CAS  PubMed  Google Scholar 

  23. Bierman PJ, Lynch JC, Bociek RG et al. The International Prognostic Factors Project score for advanced Hodgkin's disease is useful for predicting outcome of autologous hematopoietic stem cell transplantation. Ann Oncol 2002; 13: 1370–1377.

    Article  CAS  PubMed  Google Scholar 

  24. Santoro A, Bredenfeld H, Devizzi L et al. Gemcitabine in the treatment of refractory Hodgkin's disease: results of a multicenter phase II study. J Clin Oncol 2000; 18: 2615–2619.

    Article  CAS  PubMed  Google Scholar 

  25. Lazzarino M, Corso A, Barbarano L et al. DCEP (dexamethasone, cyclophosphamide, etoposide, and cisplatin) is an effective regimen for peripheral blood stem cell collection in multiple myeloma. Bone Marrow Transplant 2001; 28: 835–839.

    Article  CAS  PubMed  Google Scholar 

  26. Chau I, Harries M, Cunningham D et al. Gemcitabine, cisplatin and methylprednisolone chemotherapy (GEM-P) is an effective regimen in patients with poor prognostic primary progressive or multiply relapsed Hodgkin's and non-Hodgkin's lymphoma. Br J Haematol 2003; 120: 970–977.

    Article  CAS  PubMed  Google Scholar 

  27. Weinstein JN, Myers TG, O'Connor PM et al. An information-intensive approach to the molecular pharmacology of cancer. Science 1997; 275: 343–349.

    Article  CAS  PubMed  Google Scholar 

  28. Haldar S, Jena N, Croce CM . Antiapoptosis potential of bcl-2 oncogene by dephosphorylation. Biochem Cell Biol 1994; 72: 455–462.

    Article  CAS  PubMed  Google Scholar 

  29. Younes A, Cabanillas F, McLaughlin PW et al. Preliminary experience with paclitaxel for the treatment of relapsed and refractory Hodgkin's disease. Ann Oncol 1996; 7: 1083–1085.

    Article  CAS  PubMed  Google Scholar 

  30. Kallab AM, Danier P . A case of primary refractory Hodgkin's disease treated successfully with paclitaxel. Am J Hematol 1999; 60: 248.

    Article  CAS  PubMed  Google Scholar 

  31. Rapoport AP, Meisenberg B, Sarkodee-Adoo C et al. Autotransplantation for advanced lymphoma and Hodgkin's disease followed by post-transplant rituxan/GM-CSF or radiotherapy and consolidation chemotherapy. Bone Marrow Transplant 2002; 29: 303–312.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kaplan EL, Meier P . Nonparametric estimation from incomplete observation. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  33. Cox DR . Regression models and life tables. J R Stat Soc Ser B 1972; 74: 187–220.

    Google Scholar 

  34. Schnell R, Staak O, Borchmann P et al. A phase I study with an anti-CD30 ricin A-chain immunotoxin (Ki-4.dgA) in patients with refractory CD30+ Hodgkin's and non-Hodgkin's lymphoma. Clin Cancer Res 2002; 8: 1779–1786.

    CAS  PubMed  Google Scholar 

  35. Borchmann P, Treml JF, Hansen H et al. The human anti-CD30 antibody 5F11 shows in vitro and in vivo activity against malignant lymphoma. Blood 2003; 15: 3737–3742.

    Article  Google Scholar 

  36. Heuser C, Diehl V, Abken H, Hombach A . Anti-CD30-IL-12 antibody-cytokine fusion protein that induces IFN-gamma secretion of T cells and NK cell-mediated lysis of Hodgkin's lymphoma-derived tumor cells. Int J Cancer 2003; 106: 545–552.

    Article  CAS  PubMed  Google Scholar 

  37. Borchmann P, Schnell R, Fuss I et al. Phase I trial of the novel bispecific molecule H22xKi-4 in patients with refractory Hodgkin lymphoma. Blood 2002; 100: 3101–3107.

    Article  CAS  PubMed  Google Scholar 

  38. Carella AM, Cavaliere M, Lerma E et al. Autografting followed by nonmyeloablative immunosuppressive chemotherapy and allogeneic peripheral-blood hematopoietic stem cell transplantation as treatment of resistant Hodgkin's disease and non-Hodgkin's lymphoma. J Clin Oncol 2000; 18: 3918–3924.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the inpatient and outpatient nurses of the BMT unit for excellent care of the patients and Michele Mullins for expert assistance with the manuscript.

Acknowledgement for Research Support: Aaron P. Rapoport is a Clinical Scholar of the Leukemia and Lymphoma Society.

Author information

Authors and Affiliations

  1. University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA

    A P Rapoport, C Guo, A Badros, R Hakimian, G Akpek, E Kiggundu, B Meisenberg, H Mannuel, N Takebe, R Fenton, J Bolaños-Meade, M Heyman, I Gojo, K Ruehle, S Natt, B Ratterree, T Withers, C Sarkodee-Adoo, G L Phillips & G Tricot

Authors
  1. A P Rapoport
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Badros
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Hakimian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G Akpek
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E Kiggundu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B Meisenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H Mannuel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. N Takebe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. R Fenton
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. J Bolaños-Meade
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M Heyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. I Gojo
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. K Ruehle
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. S Natt
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. B Ratterree
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. T Withers
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. C Sarkodee-Adoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. G L Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. G Tricot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A P Rapoport.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rapoport, A., Guo, C., Badros, A. et al. Autologous stem cell transplantation followed by consolidation chemotherapy for relapsed or refractory Hodgkin's lymphoma. Bone Marrow Transplant 34, 883–890 (2004). https://doi.org/10.1038/sj.bmt.1704661

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1704661

Keywords

This article is cited by

Search

Advanced search

Quick links