- 作者：Rajni Sinha ; Pareen J. Shenoy ; Nassoma King ; Mary Jo Lechowicz ; Kevin Bumpers ; Donald Hutcherson ; Martha Arellano ; Amelia Langston ; Jonathan Kaufman ; Leonard T. Heffner Jr. ; Edmund K. Waller ; Ajay Nooka ; Christopher R. Flowers ; Sagar Lonial
- 关键词：Chemotherapy ; Hematopoietic stem cell transplantation ; Mobilization ; Treatment
- 刊名：Clinical Lymphoma Myeloma and Leukemia
- 出版年：December, 2013
- 年：2013
- 卷：13
- 期：6
- 页码：657-663
- 全文大小：401 K
Background
For Hodgkin lymphoma (HL) patients with refractory or relapsed (R/R) disease after primary therapy, the standard of care is a salvage regimen followed by autologous stem cell transplant (ASCT). However, patients who fail to respond to a salvage regimen have limited options. Our phase I study of cytarabine combined with fixed doses of vinorelbine, paclitaxel, etoposide, and cisplatin (VTEPA) for patients with R/R lymphoma showed an overall response rate (ORR) of 33%.Patients and Methods
To further examine the effectiveness of VTEPA, we conducted a retrospective review of 30 cases of R/R HL who received a salvage combination of VTEPA.
Results
This population included 15 men (50%), 18 stage III/IV (60%), and 14 with an International Prognostic Score 鈮? (47%). The median number of previous regimens was 2 (range, 1-4), 19 patients (63%) received previous salvage therapy with ifosfamide, carboplatin, and etoposide. Twenty-seven patients were evaluable for response. The most common Grade 3/4 toxicities were pancytopenia (19 patients, 97%), nausea/vomiting (17, 57%), fatigue (14, 47%), and infection (6, 20%). Of the 27 patients evaluable for response, the ORR was 70% (7 complete response and 12 partial response). Twenty patients (66%) went on to ASCT and 1 patient underwent allogeneic transplant. With a median follow-up of 32 months, the median progression-free survival (PFS) and overall survival (OS) in patients who received transplantation after VTEPA were 28 and 38 months, respectively.
Conclusion
Treatment with VTEPA for R/R HL is feasible with manageable side effects. With a high ORR, the PFS and OS for this group of patients suggest that VTEPA is a promising regimen for HL patients in whom previous lines of therapy have failed.