Autologous Peripheral Stem Cell Transplantation(ASCT) for Refractory or Recurrent Hodgkin Lymphoma.

We performed retrospective analysis of ASCT with high-dose therapy consisting of etoposide and cyclophosphamide with cytosine arabinoside or carboplatinum in 11 pts with primary refractory or recurrent Hodgkin lymphoma.

Pts and method: The patients were treated by ASCT from December 1992 to July 2005 in the hospital. Pts characteristics at initial diagnosis were male 4, female 7, and median age 40 year-old (range 33–40) at initial diagnosis. Histological types were NS: 7, MC: 2 and LP: 2. Clinical stages were 2A:3, 3A: 1, 3B: 3, 4A:2 and 4B: 2. Disease status at ASCT was 1st PR: 8 and 1st recurrence: 2 and 2nd recurrence: 1. Two of 11 pts had a history of prior radiotherapy. Peripheral blood stem cell harvesting was performed followed by late phase of initial chemotherapy or high dose etoposide for salvage therapy with granulocyte stimulating factor. All pts were restaged at 1 month or more after transplantation to evaluate the response to the high dose chemotherapy itself. The response to radiotherapy following ASCT was evaluated 2 months after completion of radiotherapy.

Results: Response to high dose chemotherapy was CR 6 pts and PR 5 pts. Five PR pts were treated with radiation and achieved CR. Cumulative response rate in high-dose chemotherapy with/without radiotherapy was 100%. Median follow-up period was 119 months (range 14–145). No recurrent case was observed. However one of these patients had inexplicable cardiac arrest at 100 months after ASCT. Although the patient survived, it was necessary for her to be in hospital by reason of severe anoxic encephalopathy.

Discussion: ASCT for Hodgkin’s lymphoma seems to be feasible salvage therapy in intractable case. However high-dose chemotherapy alone was poor potential to be cure in our limited experience. If high-dose chemotherapy induces PR, radiotherapy should be scheduled based on careful therapeutic response evaluation of high-dose chemotherapy.