Improved outcome of patients with relapsed/refractory Hodgkin lymphoma with a new fotemustine-based high-dose chemotherapy regimen

Maurizio Musso, Giuseppe Messina, Nicola Di Renzo, Paolo Di Carlo, Umberto Vitolo, Renato Scalone, Gianpaolo Marcacci, Tiziana Moscato, Rossella Matera, Alessandra Crescimanno, Stella Santarone, Enrico Orciuolo, Anxur Merenda, Vincenzo Pavone, Domenico Pastore, Daniela Donnarumma, Chiara Ciochetto, Anna Mele, Francesco Lanza, Erminio BonizzoniAntonello Pinto

Research output: Contribution to journalArticle

Abstract

High-dose chemotherapy (HDT) with autologous stem cell transplantation is the standard of care for relapsed/refractory (RR) Hodgkin lymphoma (HL). Given that HDT may cure a sizeable proportion of patients refractory to first salvage, development of newer conditioning regimens remains a priority. We present the results of a novel HDT regimen in which carmustine was substituted by a third-generation chloroethylnitrosourea, fotemustine, with improved pharmacokinetics and safety (FEAM; fotemustine, etoposide, cytarabine, melphalan) in 122 patients with RR-HL accrued into a prospective registry-based study. Application of FEAM resulted in a 2-year progression-free survival (PFS) of 73·8% [95% confidence interval (CI), 0·64-0·81] with median PFS, overall survival and time to progression yet to be reached. The 2-year risk of progression adjusted for the competitive risk of death was 19·4% (95% CI, 0·12-0·27) for the entire patient population. Most previously established independent risk factors, except for fluorodeoxyglucose (18FFDG)-uptake, were unable to predict for disease progression and survival after FEAM. Although 32% of patients had 18FFDG-positrin emission tomography-positive lesions before HDT, the 2-year risk of progression adjusted for competitive risk of death was 19·4% (95% CI; 0·12-0·27). No unusual acute toxicities or early/late pulmonary adverse events were registered. FEAM emerges as an ideal HDT regimen for RR-HL patients typically pre-exposed to lung-damaging treatments.

Original languageEnglish
Pages (from-to)111-121
Number of pages11
JournalBritish Journal of Haematology
Volume172
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

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Keywords

  • Autologous stem cell transplantation
  • Fotemustine
  • High-dose chemotherapy
  • Hodgkin lymphoma

ASJC Scopus subject areas

  • Hematology

Cite this

Musso, M., Messina, G., Di Renzo, N., Di Carlo, P., Vitolo, U., Scalone, R., Marcacci, G., Moscato, T., Matera, R., Crescimanno, A., Santarone, S., Orciuolo, E., Merenda, A., Pavone, V., Pastore, D., Donnarumma, D., Ciochetto, C., Mele, A., Lanza, F., ... Pinto, A. (2016). Improved outcome of patients with relapsed/refractory Hodgkin lymphoma with a new fotemustine-based high-dose chemotherapy regimen. British Journal of Haematology, 172(1), 111-121. https://doi.org/10.1111/bjh.13803