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Intensified chemo regimen no benefit in relapsed Hodgkin’s lymphoma

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – High-dose chemo followed by autologous stem-cell transplantation achieves good results in patients with relapsed Hodgkin’s lymphoma, and outcomes are not improved by additional sequential high-dose chemotherapy before myeloablative therapy. In fact, it just increases toxicity, European investigators report.

The findings are reported in the Journal of Clinical Oncology issued online October 25, by Dr. Andreas Engert at University Hospital Cologne, Germany, and colleagues.

The authors note that high-dose chemotherapy (HDCT) followed by autologous stem-cell transplantation has become standard of care in patients with relapsed Hodgkin’s lymphoma. To see if results could be improved further, the researchers conducted a clinical trial to investigate the effect of adding sequential HDCT to the conventional regimen, prompted by promising prior results.

In the trial, 281 patients with relapsed Hodgkin’s lymphoma first received induction therapy with two cycles of DHAP (dexamethasone, cytarabine, and cisplatin).

The 241 patients who responded were then randomized to receive standard myeloablative therapy with carmustine, etoposide, cytarabine, and melphalan (BEAM) followed by stem-cell transplantation, or to receive cyclophosphamide, methotrexate, and etoposide sequentially in high-doses before BEAM and stem-cell transplantation.

Treatment was longer for patients in the sequential HDCT group than the standard treatment group (4 months versus 2 months), and more of them experienced grade 4 toxicity (88% vs 45%) before BEAM and transplantation.

The intensified regimen did not pay off in terms of any survival benefit. At 3 years, overall survival was 87% in the standard arm and 80% in the intensified arm (p=0.816). Corresponding rates of progression-free survival were 72% and 67% (p=0.505), according to the report.

“In conclusion, we did not observe any advantage of further dose intensification using additional sequential HDCT in patients with relapsed Hodgkin’s lymphoma,” Dr. Engert and colleagues write. “Based on the data presented here, two cycles of intensified conventional chemotherapy (DHAP) followed by HDCT (BEAM) is an effective and safe treatment for patients with relapsed Hodgkin’s lymphoma.”

Reference:

Dose Intensity of Chemotherapy in Patients With Relapsed Hodgkin’s Lymphoma

J Clin Oncol 2010