MiCMA: An alternative treatment for refractory or recurrent Hodgkin's disease

• Published in: Annals of oncology Vol. 11; no. 7; pp. 867 - 871
• Main Authors: La Barbera, E. Ortu, Chiusolo, P., Laurenti, L., Menichella, G., Di Febo, A. L., Piccirillo, N., Sorà, F., Marra, R., Teofili, L., Leone, G., Sica, S.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.07.2000
• Subjects: Adolescent; Adult; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carboplatin - administration & dosage; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Cytarabine - administration & dosage; Female; Hematopoietic Stem Cell Transplantation; Hodgkin Disease - drug therapy; Hodgkin Disease - pathology; Hodgkin's disease; Humans; Male; Medical sciences; Methylprednisolone - administration & dosage; MiCMA; Middle Aged; Mitoxantrone - administration & dosage; Pharmacology. Drug treatments; Prognosis; Recurrence; salvage therapy; stem-cell transplantation; Treatment Outcome; Antineoplastic agent; Recurrence; Toxicity; Stem cell; Methylprednisolone; Cytarabine; Lymphoproliferative syndrome; Immunotherapy; Clinical trial; Graft; Remission; Mitoxantrone; Platinum II Complexes; Human; Corticosteroid; Drug combination; Anthraquinone derivatives; Treatment efficiency; Hodgkin disease; Malignant hemopathy; Autologous system; Lymphoma; Chemotherapy; Sensitivity resistance; Treatment; Carboplatin; Combined treatment
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1023/A:1008329127887

Background: We determined the response rate to MiCMA (mitoxantrone, carboplatinum, methylprednisolone and aracytin) in a group of 29 patients with Hodgkin's disease (HD) and poor prognostic factors either resistant to first line or relapsing after conventional chemotherapy and subsequently evaluated the role of autologous stem-cell transplantation (ASCT) in these patients after MiCMA. Patients and methods: The treatment was intended as a brief tumor debulking program before ASCT. Twenty-nine patients with primary refractory HD or relapsed HD were submitted to two courses of MiCMA (mitoxantrone 10 mg/m2 day 1; carboplatinum 100 mg/m2 days 1–4; aracytin 2 g/m2 day 5; methylprednisolone 500 mg/m2 days 1–5) and subsequently evaluated for response. Those with responding or stable disease, received one or two other courses of MiCMA followed by ASCT. Results: There were 10 complete responses (34% CR), 15 partial responses (52% PR) and 4 treatment failures with disease progression (14% PD). In total there were 25 evaluable responses out of 29 patients (86% CR + PR). Myelosuppression was the main toxicity of this treatment. At this time 20 patients (69%) are alive with a median follow-up of 26.5 months (7–100), 13 patients in CR (45%), 8 patients died, 7 of them from disease progression and one due to multi-organ failure, one patient is lost to follow-up. All but one of the patients who achieved CR after MiCMA are alive. Only the number of extranodal sites was found to predict a poor response to MiCMA. Conclusions: A short pre-transpiantation treatment with MiCMA is an effective tumor debulking approach in patients with refractory or relapsed HD.