12th Congress of the European Hematology ... - Haematologica

0179
ESHAP VS GIN AS SALVAGE AND MOBILIZING REGIMENS IN RELAPSED OR
REFRACTORY HL
P. Tsirkinidis, T.P. Vassilakopoulos, M. Moschogiannis, Z. Galani,
K. Anargyrou, S. Masouridis, F. Kontopidou, S. Sachanas,
E. Dimitriadou, V. Kalotychou, C. Kalpadakis, A. Antoniadis,
E. Prassas, D. Chasiotis, E. Variami, N.-A. Viniou, S. Kokoris,
M. Siakantaris, Y. Rombos, G.A. Pangalis, M. Angelopoulou
University of Athens, ATHENS, Greece
Background. Patients with relapsed or refractory HL are treated with
salvage chemotherapy and subsequent high dose therapy and autologous
stem cell transplantation (HDT/ASCT). Salvage chemotherapy aims to
disease debulking, testing of chemosensitivity , as well as mobilization
of peripheral blood stem cells. Platinum-based regimens (DHAP, ESHAP,
ICE) are frequently used for this purpose. However, the optimal salvage
chemotherapy regimen is still not known. Recently the combination of
gemcitabine, ifosphamide, vinorelbine and methylprednisolone (GIN)
has been shown to be an effective salvage and mobilizing regimen in HL.
Aims. To compare the efficacy of ESHAP (etoposide, methylprednisolone,
high dose cytarabine and cis-platinum) vs GIN chemotherapy
as 2nd line treatment for relapsed or refractory HL patients eligible for
HDT/ASCT. Methods. Between 2001 and 2006 most patients scheduled
for ASCT received ESHAP as first salvage (n=37), while GIN was introduced
as first salvage during the last year (n=10). We retrospectively
compared these two regimens regarding mobilization parameters, disease
control (overall response rate) and a combined endpoint, including
both successful mobilization and disease control prior to ASCT. Results.
Patients’ characteristics did not differ between ESHAP and GIN groups,
except of bulky disease at relapse/progression, which was more frequent
in the latter (3 vs 1 patient, p=0.047). GIN was more effective as a mobilizing
regimen: peak circulating CD34 + cell count was higher (median
206.2 vs 75.2, p=0.003), the number of total CD34 + collected cells was
higher (median 14.71×106 /kg vs 4.32×106 /kg, p=0.002), while all patients
were successfully mobilized with GIN vs 90% in the ESHAP group. In
addition, time to neutrophil engraftment following ASCT was faster
with GIN (median 9 vs 10 days, p=0.02). The median time to apheresis
was also shorter with GIN (12 vs 16 days, p