Universität zu Köln

Josting, Andreas, Mueller, Horst, Borchmann, Peter, Baars, Joke W., Metzner, Bernd ORCID: 0000-0002-1496-1377, Doehner, Hartmut, Aurer, Igor, Smardova, Lenka, Fischer, Thomas, Niederwieser, Dietger, Schaefer-Eckart, Kerstin, Schmitz, Norbert, Sureda, Anna, Glossmann, Jan, Diehl, Volker, DeJong, Daphne, Hansmann, Martin-Leo, Raemaekers, John and Engert, Andreas (2010). Dose Intensity of Chemotherapy in Patients With Relapsed Hodgkin's Lymphoma. J. Clin. Oncol., 28 (34). S. 5074 - 5081. ALEXANDRIA: AMER SOC CLINICAL ONCOLOGY. ISSN 1527-7755

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Abstract

Purpose High-dose chemotherapy (HDCT) followed by autologous stem-cell transplantation (PBSCT) has become the standard treatment for patients with relapsed Hodgkin's lymphoma (HL). The intensity of treatment needed is unclear. This European intergroup study evaluated the impact of sequential high-dose chemotherapy (SHDCT) before myeloablative therapy. Patients and Methods Patients with histologically confirmed, relapsed HL were treated with two cycles of dexamethasone, cytarabine, and cisplatin, and those without disease progression were randomly assigned. In the standard arm (A), patients received myeloablative therapy with carmustine, BEAM (carmustine, etoposide, cytarabine, and melphalan) followed by PBSCT. Patients in the experimental arm (B) also received sequential cyclophosphamide, methotrexate, and etoposide in high-doses before BEAM. Freedom from treatment failure (FFTF) was the primary end point. Remission rates, overall survival (OS), and toxicity of treatment were secondary end points. Results From a total of 284 patients included, 241 responding patients were randomly assigned after two cycles of dexamethasone, cytarabine, and cisplatinum. Patients treated in arm B had longer treatment duration and experienced more toxicity and protocol violations (P < .05). Mortality was similar in both arms (20% and 18%). With a median observation time of 42 months, there was no significant difference in terms of FFTF (P = .56) and OS (P = .82) between arms. FFTF at 3 years was 62% (95% CI, 56% to 68%) and OS was 80% (95% CI, 75% to 85%). Patients with stage IV, early relapse, multiple relapse, anemia, or B symptoms had a higher risk of recurrence (P < .001). Conclusion Compared with conventional high-dose chemotherapy, additional SHDCT is associated with more adverse effects and does not improve the prognosis of patients with relapsed HL. J Clin Oncol 28:5074-5080.(C) 2010 by American Society of Clinical Oncology

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Josting, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Horst UNSPECIFIED UNSPECIFIED UNSPECIFIED Borchmann, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Baars, Joke W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Metzner, Bernd UNSPECIFIED orcid.org/0000-0002-1496-1377 UNSPECIFIED Doehner, Hartmut UNSPECIFIED UNSPECIFIED UNSPECIFIED Aurer, Igor UNSPECIFIED UNSPECIFIED UNSPECIFIED Smardova, Lenka UNSPECIFIED UNSPECIFIED UNSPECIFIED Fischer, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Niederwieser, Dietger UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer-Eckart, Kerstin UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmitz, Norbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Sureda, Anna UNSPECIFIED UNSPECIFIED UNSPECIFIED Glossmann, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Diehl, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED DeJong, Daphne UNSPECIFIED UNSPECIFIED UNSPECIFIED Hansmann, Martin-Leo UNSPECIFIED UNSPECIFIED UNSPECIFIED Raemaekers, John UNSPECIFIED UNSPECIFIED UNSPECIFIED Engert, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-491659
DOI:	10.1200/JCO.2010.30.5771
Journal or Publication Title:	J. Clin. Oncol.
Volume:	28
Number:	34
Page Range:	S. 5074 - 5081
Date:	2010
Publisher:	AMER SOC CLINICAL ONCOLOGY
Place of Publication:	ALEXANDRIA
ISSN:	1527-7755
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BONE-MARROW-TRANSPLANTATION; STEM-CELL TRANSPLANTATION; COLONY-STIMULATING FACTOR; SEQUENTIAL CHEMORADIOTHERAPY; COMBINATION CHEMOTHERAPY; PROGNOSTIC-FACTORS; SALVAGE TREATMENT; RANDOMIZED-TRIAL; DISEASE STATUS; THERAPY Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/49165