769 High dose therapy and autologous bone marrow transplantation for relapsed or refractory hodgkin's disease: The impact of total body irradiation and involved field radiation therapy

Abstract

One hundred patients with relapsed/refractory Hodgkin's disease (HD) were treated with either high dose carmustine(BCNU)/etoposide(VP16)/cyclophosphamide(Cy) or fractionated total body irradiation (fTBI)/Vpl6/Cy prior to autologousbone marrow transplantation (ABMT). In addition, 24 patients received involved field radiation therapy (RT) prior to (n = 18) or following (n = 6) ABMT. With a median follow-up of 30 months, 3-year actuarial freedom from relapse (FFR) and overall survival (OS) for the entire group are 65% and 63% respectively. By multivariate analyses, factors associated with recurrence were pleural disease ( P = 0.009), pulmonary metastases ( P = 0.004) and a poor response to cytoreductive therapy ( P = 0.003). FFR and OS following BCNU/VP16/Cy (67% and 62%) or fTBI/VP16/Cy (60% and 60%) were similar ( P = 0.51 and P = 0.49). A median RT dose of 30 Gy (range 14.4 Gy–45 Gy) was given to 67 sites in the 24 patients. Local failure occurred within 4 irradiated sites (6%) in two patients (8%). In patients with Ann Arbor stages I–III disease (n = 62), RT was associated with a trend toward improved FIR (92% -vs-67%, P = 0.09) and OS (86% -vs- 59%, P = 0.13). Among patients not previously irradiated (n = 39), RT was associated with a significant improvement in FFR (85% -vs- 55%, P = 0.05) and OS (93% -vs- 54%, P = 0.03). Treatment related mortality (including 2nd malignancies) was similar with or without fTBI (15% -vs- 14%) or RT (17% -vs-13%). In conjunction with high dose therapy and ABMT, RT is well tolerated, effectively controls local/regional disease, and may improve survival in selected patients.