Double High Dose Salvage Therapy With Dose-Intensified Cyclophosphamide, Etoposide, and Cisplatin (DICEP) Re-Induction Followed by High-Dose Melphalan (HDM) and Autologous Stem Cell Transplantation (ASCT) Consolidation for Relapsed/Refractory Hodgkin Lymphoma
Bibliographic record
Abstract
The purpose of this study was to retrospectively review our results of double high-dose therapy with DICEP re-induction followed by HDM and ASCT for this patient population. Between June 1995 and November 2009, 73 patients with relapsed (43) or refractory (30) classical HL were treated with DICEP (dose-intensified cyclophosphamide 5.25 g/m2, etoposide 1050 mg/m2, and cisplatin 105 mg/m2) with autologous blood stem cell apheresis performed upon hematopoietic recovery, followed 2-3 weeks later by HDM (melphalan 200 mg/m2) and ASCT. Patient characteristics included: age 20-63 years (median 37); bulk > 5 cm = 39, bulk > 10 cm = 12; number of prior chemotherapy regimen(s) failed 1 = 63, 2-4 = 10; prior radiotherapy = 30; initial time to progression < 3 months = 30, 3-12 months = 21, and > 12 months = 22; median time from diagnosis to ASCT 15 months (range 4-324); B symptoms = 18; and International Prognostic Score (IPS) 0-1 = 19, 2 = 26, 3 = 17, 4-7 = 11. DICEP chemotherapy resulted in successful stem cell mobilization in 71 patients (97%), with a median CD34+ cell count of 15.6 x106/kg (range 4.7-70.9 x106/kg). 63 patients (86%) responded to DICEP, including 13 complete responses (18%). 4 patients did not proceed to HDM-ASCT; two failed to mobilize stem cells, one experienced grade IV infection, and one experienced bleeding and respiratory arrest with anoxic brain injury following removal of an internal jugular apheresis catheter following stem cell collection. The latter patient was the only treatment-related death following DICEP. With a median follow-up of 56 months post-DICEP (range 3-170 months), the 5-year PFS and OS rates were 61% [95%CI = 49-72%] and 80% [95%CI = 69-89%], respectively. The 5 year PFS was 65% vs. 30% for DICEP responders vs. non-responders (logrank p = 0.003), and 89% for IPS score = 0-1, 56% for IPS = 2-3, and 24% for IPS = 4-7 (logrank p < 0.001). Response to DICEP and relapse IPS were the only two factors that independently predicted PFS and OS in multivariate analysis. Of the 26 patients who relapsed following DICEP±HDM/ASCT, 7 (27%) achieved subsequent long-term PFS of ≥ 3 years using radiotherapy (n = 1), chemotherapy and radiotherapy (n = 2), or allogeneic SCT (n = 4). DICEP-HDM/ASCT for relapsed/refractory Hodgkin lymphoma is associated with excellent stem cell mobilization capability and favourable PFS and OS outcomes. These results compare favourably to previously reported alternative regimens and require validation in a prospective multi-centre clinical trial.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".