Salvage therapy in relapsed Hodgkin's lymphoma patients
Elena S. Belyaeva, Olga V. Morozova, Andrey I. Slugin, Alexander V. Popa, Georgy L. Mentkevich
N. N. Blokhin RCRC RAMS, Pediatric Oncology and Hematology Research Institute, Moscow, Russia
Summary
The treatment of children with refractory or early relapsed Hodgkin's lymphoma remains one of the most important problems in pediatric oncology. In order to improve the outcome of this group of patients we used the ViGePP regimen. We present the results of the ViGePP regimen for children with relapsed/refractory LH.
Method
Between 2008 and 2009, 9 pts with relapsed/refractory LHwere enrolled in this study. Of the 9, 4 pts had refractory LH. The median age was 15.1 y. CR (from 6–48 mo) lasted for a median of 21 mo in 5 pts.
Induction therapy consisted with 2–5 cycles of ViGePP (gemcitabine – 1000 mg/m2/d 1,8,15 d., vinorelbine – 30 mg/m2/d 1,8 d, procarbazine 100 mg/m2/d 1–7 d., prednisolone 30 mg/m2/d 1–15 d).
Results
The response rate was assessed after 2 cycles of ViGePP: CR – 3, PR – 6. After the end of treatment the status was CR – 7, PR – 1. One pt continues treatment. Two pts have been in CRII for 15 and 12 mo. One has been in CRIII for 2 mo. Two pts had a fourth relapse 7 and 9 mo after the end of treatment. Two pts in CR have been allocated for consolidation SCT. One pt died from sepsis after ASCT.
Hematological toxicity: leukopenia grade 3 (n=4), grade 4 (n=3), thrombocytopenia grade 4 (n=2), grade 3 (n=5), anemia grade 3 (n=4).
Non–hematological toxicity: mucositis grade 2 (n=2), grade 1 (n=2), gastrointestinal grade 3 (n=1), grade 2 (n=1). Liver toxicity (ALT, AST) grade 3 (n=4), grade 2 (n=3). Heart and kidney toxicity > grade 1 were not observed.
Conclusion
The ViGePP regimen was effective in 6/9 LH pts. Toxicity was acceptable. Future studies are warranted to evaluate larger cohorts of pts with relapsed and refractory LH.
Keywords
Hodgkin’s lymphoma, children, relapse, therapy, ViGePP
