Efficacy and toxicity of a CCNU-containing high-dose chemotherapy regimen followed by autologous hematopoietic cell transplantation in relapsed or refractory Hodgkin's disease

Monic J. Stuart, Nelson S. Chao, Sandra J. Horning, Ruby M. Wong, Robert S. Negrin, Laura J. Johnston, Judith A. Shizuru, Gwynn D. Long, Karl G. Blume, Keith E. Stockerl-Goldstein

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

High-dose CBV (cyclophosphamide, carmustine, and etoposide) in combination with autologous HCT achieves survival rates of approximately 50% at 5 years in recurrent or refractory Hodgkin's disease (HD). However, carmustine (BCNU) dose-dependent pulmonary toxicity occurs in 20% to 30% of patients. A decreased incidence of interstitial pneumonitis as well as a possible benefit in efficacy has been reported with lomustine (CCNU) compared to BCNU in the standard dose setting. In a dose-escalation study, we substituted CCNU for BCNU in the CBV regimen for 16 patients with HD (n = 12) or non-Hodgkin's lymphoma (n = 4). Based on the promising results, an additional 47 consecutive patients with HD were treated with the following regimen: CCNU (15 mg/kg) orally on day -6, etoposide (60 mg/kg) intravenously on day -4, and cyclophosphamide (100 mg/kg) intravenously on day -2. Peripheral blood progenitor cells and/or bone marrow were infused on day 0. With a median follow-up for the surviving patients of 3.2 years (range, 0.8-9.9 years), the 3-year overall survival rate was 57% (CI, ±15%), event-free survival was 52% (CI, ±14%), and freedom from progression was 68% (CI, ±14%). There were 21 deaths, 10 due to HD. Six patients died due to respiratory failure. Interstitial pneumonitis occurred in 63% of patients and could not be correlated with prior chest radiotherapy. This regimen demonstrated survival rates similar to those of historical studies that used the CBV regimen. However, the incidence of interstitial pneumonitis was in excess of expected.

Original languageEnglish
Pages (from-to)552-560
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume7
Issue number10
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

Keywords

  • CCNU
  • Hematopoietic cell transplantation
  • High-dose chemotherapy
  • Hodgkin's disease

Fingerprint Dive into the research topics of 'Efficacy and toxicity of a CCNU-containing high-dose chemotherapy regimen followed by autologous hematopoietic cell transplantation in relapsed or refractory Hodgkin's disease'. Together they form a unique fingerprint.

Cite this