Factors Affecting Outcome of Patients with Refractory/Relapsed Hodgkin’s Disease (HD) Treated with IGEV Chemotherapy (CT) and High Dose Consolidation Therapy (HDT) with Stem Cell Rescue
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Media type:
E-Article
Title:
Factors Affecting Outcome of Patients with Refractory/Relapsed Hodgkin’s Disease (HD) Treated with IGEV Chemotherapy (CT) and High Dose Consolidation Therapy (HDT) with Stem Cell Rescue
Description:
<jats:title>Abstract</jats:title>
<jats:p>Purpose: to identify prognostic factors in pts with relapsing/refractory HD treated with IGEV CT and HDT</jats:p>
<jats:p>Methods: From 01/98 to 01/05 104 patients (pts) from our institutions with relapsed/refractory HD received 4 induction cycles of IGEV (ifosfamide 2000 mg/mq d 1–4; gemcitabine 800 mg/mq d 1& 4; vinorelbine 20 mg/mq d 1; prednisolone 100 mg/mq d 1–4, and G-CSF) and HDT consolidation. Prognostic factors for freedom for progression (FFP) were analyzed by means of the chi-square and Fisher’s exact tests. Multivariate regression logistic analysis was then applied for variable associated with outcome.</jats:p>
<jats:p>Results: Main pt characteristics at accrual: M/F 56/48, median age 31 (range 17–65), refractory/relapsed following last CT course 40/64, median previous CT regimens: 1 (range 1–2), simptoms A/B 32/71, Hasenclever (IPS) score <3/≥ 4: 72/24 (8 pts not evaluable), LDH ratio ≤ 1/> 1: 68/35, previous radiotherapy (RT) yes/no: 62/42. After induction, 45 pts (43%) obtained complete remission (CR), 41(40%) partial remission (PR) and18 (17)% di not response (NR). Overall 89 pts received HDT and at the end of the treatment program 76 out of 104 pts were in CR. On an intent-to treat analysis, two-year freedom from progression (FFP) and overall survival (OS) for the whole series were 47% and 74,6%, respectively.</jats:p>
<jats:p>In univariate analysis FFP was negatively influenced by B symptoms, IPS score ≥ 4, LDH ratio > 1, refractory disease, and by response to IGEV (see table).</jats:p>
<jats:p>Multivariate analysis revealed that factors retaining statistical significance were refractory disease, B symptoms, high IPS score and chemoresistance (see table).</jats:p>
<jats:p>Conclusions: based on this analysis, a prognostic model for IGEV-treated patients with refractory/relapsed HD can be constructed.</jats:p>
<jats:p>Factors influencing FFP Factor ≥ FFP p (univariate) p(multivariate) Symptoms B/A 16/57% 0.003 0.007 IPS > 4/< 3 32/51% 0.0035 0.051 LDH >1/<1− 19/61% 0.003 n.s. refrac/relaps 22.5/62% < 0.001 0.012 < CR/CR to IGEV 32/68% 0.002 n.s. NR/CR + PR 23.5/52% 0.001 0.005</jats:p>