Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 22, No 14S (July 15 Supplement), 2004: 6598
© 2004 American Society of Clinical Oncology

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Abstract

Phase II study of EPOCH infusional chemotherapy in relapsed or refractory Hodgkin's lymphoma (HL). A report on toxicity, efficacy and prognostic indicators of outcome

National Cancer Institute, Bethesda, MD

6598

Background: In relapsed/refractory HL, an effective and well tolerated salvage regimen has important roles both prior to autologous stem cell transplant (SCT) and as palliative therapy in patients (pts) who are ineligible for or have failed SCT. Methods: Eligible pts had relapsed/refractory HL and adequate organ function unless due to HL. Pts received fixed dose EPOCH chemotherapy (etoposide 200 mg/m², vincristine 1.6 mg/m² (no cap) and doxorubicin 40 mg/m² CIVI x 96-hrs D1–4; cyclophosphamide 750 mg/m² IV D5 and prednisone 60 mg/m² qd D1–6 ) with G-CSF q21 days until disease progression or stabilization over 2 cycles. Results: Of 54 pts, median (range) age was 31 yrs (19–64), 35 (66%) were male, stage was III in 11(21%) and IV in 30(56%), and 29 (55%) had B symptoms. Histology included nodular sclerosis 34 (64%), mixed cellularity 3 (25%), and lymphocyte depleted 5 (9%) classical HL, and nodular lymphocyte predominant HL 1 (2%). 24 (45%) pts had had 2 prior regimens, 27 (51%) pts received chemotherapy within the previous 10 mos, and 40 (75%) pts had responded to their last treatment. Over 202 cycles, toxicities included fever and neutropenia on 9 (4%), grade (gr) 4 neutropenia on 31 (15%), gr 4 thrombocytopenia on 20 (10%), and gr 2 gastrointestinal toxicity on 20 (10%) cycles; gr 2 cardiotoxicity occurred in 2 (4%) and gr 2 neurotoxicity in 11 (20%) pts. There was one treatment related death. 45 (84%) pts responded with 23 (44%) CR and 21 (40%) PR. With a median follow-up of 68 mos, the median progression-free (PFS) and overall survivals (OS) are 10 and 40 mos, and at 68 mos median follow-up, PFS and OS are 21% and 41%. Among 33 pts who underwent SCT, median PFS is 15 mos and OS has not been reached. Multivariate analysis revealed that the no. of prior drugs and response to the preceding regimen significantly influenced OS and PFS; in addition PFS was significantly influenced by performance status and mos since previous chemotherapy. Conclusions: EPOCH is well tolerated and has a high response rate in relapsed/refractory HL. It should be considered as salvage therapy prior to SCT or for palliation in incurable HL.

No significant financial relationships to disclose.

Abstract presentation from the 2004 ASCO Annual Meeting