Case study Q&A: Determining the optimum salvage therapy and salvage regimen скачать в хорошем качестве

Case study Q&A: Determining the optimum salvage therapy and salvage regimen

Dr Stefano Luminari addresses several key points relating to the case presentation of a 23-year-old female presenting with classical Hodgkin lymphoma with nodular sclerosis, stage lVA The refractoriness of disease to conventional first-line chemotherapy (achievement of PR) along with a stage IV disease (bone localization) represented a poor prognostic factor in our patient. Keeping this in mind and also considering the young age and good performance status of our patient, the standard therapy had to be an aggressive salvage strategy consisting of a reinduction phase followed by high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT), with the aim of eradicating the disease. Other options such as second-line chemotherapy or local radiotherapy were not suitable in this case. The salvage chemotherapy regimen consisted of four cycles of IGEV chemotherapy with the purpose of achieving complete remission and of harvesting peripheral stem cells prior to starting with HDCT plus ASCT.1 At the present time there is no demonstrated best salvage regimen for refractory or/and relapsed HL patients. Over time, several conventional chemotherapy regimens (e.g. DHAP, ESHAP, ICE, IGEV) have shown similarly high activity prior to HDCT plus ASCT but without significant difference in terms of response rate. Additionally, no randomized trials thus far have prospectively compared these conventional salvage chemotherapy regimens. The choice for the reinduction regimen is then usually based on the experience and preference of the center. References 1. Santoro A, et al. Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin's lymphoma. Haematologica. 2007;92:35-41. http://www.haematologica.org/content/...