Retrospective analysis of salvage regimen for relapsed or refractory classical Hodgkin lymphoma

We retrospectively reviewed the outcome of 22 patients (pts) referred to our Center from 2001 to 2009, affected by relapsed or refractory classical Hodgkin lymphoma (CHL) after first line therapy with ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) associated or not with involved-field radiotherapy (IFRT) and then treated with IGEV (methylprednisolone, ifosfamide, gemcitabine and vinorelbine). The main features of the pts were the following: median age was 27 years (15-57), M:F ratio 0.7; 18 pts presented nodular sclerosis and 4 mixed cellularity; 11 pts were stage II, 5 stage III, 6 stage IV and 11 were B symptomatic; 7 pts presented bulky disease. All of them were treated with a median number of 6 cycles of ABVD (range 2-8), followed by IFRT in 10 patients; 12 pts resulted refractory and 10 relapsed after a median time of 22 months (range 6-72). All of the 22 pts were treated with IGEV as first salvage chemotherapy with the intention to perform an autologous stem cell transplantation (ASCT). The response was evaluated according to conventional criteria including PET. After a median of 3 cycles of IGEV (range 2-4), 8 pts were in complete remission (CR), 9 in partial remission (PR), 3 in stable disease (SD) and 2 in progressive disease (PD). Eleven pts (8 pts in CR and 3 in PR) underwent ASCT immediately using BEAM (BCNU, etoposide, Ara-C, and melphalan) as conditioning regimen: all of them obtained CR, except one that confirmed the PR. Of remaining 11 pts that did not obtained CR to IGEV (6 PR, 3 SD, 2 PD), 10 were treated, as second line salvage therapy, with standard BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). After a median of 3 BEACOPP cycles (range 1-4), 5 pts obtained CR, 2 PR, 1 SD and 2 PD. All of them underwent ASCT. Ten of 11 pts were evaluable: 5 were in CR, 2 in PR, 2 SD and 1 PD. After IGEV ± BEACOPP 13/22 pts obtained pre-ASCT CR. After a median follow-up of 62 months (range 17-129), 16 pts are alive, 13 in CR, 2 in PD and 1 pts developed non-Hodgkin lymphoma (NHL) 16 months after ASCT. Although the limited number of pts involved and the retrospective analysis, the study demonstrates that BEACOPP is feasible and effective salvage regimen for pts with CHL not completely responder to IGEV chemotherapy. In fact, 50% of patients refractory to IGEV treated with BEACOPP obtained a CR and could be consolidated with ASCT.