Index of pretreatment intensity predicts outcome of high-dose chemotherapy and autologous progenitor cell transplantation in chemosensitive relapse of Hodgkin's disease

Purpose: To identify prognostic factors in patients with chemosensitiverelapsed Hodgkin's disease treated by high-dose chemotherapy with autologousprogenitor cell transplantation (HDC) and to compare the duration oftreatment-free remission prior to HDC with the progression-free survivalafter HDC in individual patients.Patients and methods: Forty-five consecutive patients were analyzedretrospectively. We devised an index of pretreatment intensity (IPTI) basednumber of different chemo- and radiotherapy regimens given between diagnosisand HDC and on the duration of disease.Results: With a medianfollow-up of 47 months the post-transplant event-free survival (EFS) was44% and the overall survival (OAS) was 62% at four years. TheIPTI allowed to discriminate between a low and a high-risk group with afour-year post-transplant EFS of 66% and 11% and a OAS of87% and 28%, respectively (P = 0.0001). Of the 39 patientswith sufficient follow-up after HDC, post-transplant EFS lasted on 18.5months longer than the pretransplant treatment-free remission.Conclusions: HDC with the CBV regimen confers significant benefit topatients with chemosensitive relapsed Hodgkin's disease. The IPTI may help toselect patients with a good response to HDC and to identify poor prognosispatients suitable for experimental protocols or palliative care only.