Molecular dynamics studies on the water mixtures of pharmaceutically important ionic liquid lidocaine HCl

In this paper the molecular dynamics of a common local-anesthetic drug, lidocaine hydrochloride (LD-HCl), and its water mixtures were investigated. By means of broadband dielectric spectroscopy and calorimetric measurements it was shown that even a small addition of water causes a significant effect on the relaxation dynamics of analyzed protic ionic liquid. Apart from the two well-resolved relaxations (σ- and γ-processes) and the β-mode, identified as the JG-process, observed for anhydrous LD-HCl, a new relaxation peak (υ) is visible in the dielectric spectra of aqueous mixtures of this drug. Additionally, the significant effect of the water on the glass transition temperature of LD-HCl was found. The sample characterized with mole fraction of water X(w) = 0.44 reveals the glass transition temperature T(g), 42 K lower than that of anhydrous material (307 K). Finally, it was shown that by amorphization of the hydrochloride salt of lidocaine it is possible to obtain its room temperature ionic liquid form.

Bioactive silica-based drug delivery systems containing doxorubicin hydrochloride: in vitro studies

This study reports the applicability of sol-gel derived silica and silica-polydimethylsiloxane (silica-PDMS) composites as a potential bioactive implantable drug delivery system for doxorubicin hydrochloride (DOX). These composites also contain calcium chloride (CaCl(2)) and triethylphosphate as precursors of Ca(2+) and (PO(4))(3-) ions. These composites were immersed for 20 days in a simulated body fluid (SBF) at 37°C to study the release rate of the DOX, dissolution of the silica and the formation of hydroxyapatite on the composites' surface. The results show that the release rate of the DOX can be effectively tailored by either the addition of a polydimethylsiloxane (PDMS), or by varying the amount of CaCl(2), where the elution rate of DOX increases with increasing amount of the CaCl(2) precursor. Importantly, irrespective of the amount of CaCl(2), no burst release of DOX has been observed in any of the silica-PDMS system investigated. On the other hand, a slow release of DOX has been observed with a trend that followed a zero (0)-order kinetics for a total of 20 days of elusion. The dissolution of silica in SBF was ca. two-times faster than that of silica-PDMS, with the former reaching an average saturation level of 80 μg/mL whilst the latter reached 46 μg/mL within 20 days. Both the silica and the silica-PDMS composites show bioactivity i.e. they absorb calcium phosphate from SBF. Within 10 days, a ten-fold increase in the concentration of calcium phosphate deposit has been observed on the silica-PDMS relative to the silica. The constant rates of DOX release observed for the silica-PDMS composites indicate that the calcium phosphate deposit do not obstruct controlled release of the drug.

Influence of surfactants on the release behaviour and structural properties of sol-gel derived silica xerogels embedded with metronidazole

The aim of this study was to obtain stable and controlled release silica xerogels containing metronidazole (MT) prepared with surfactants with different charges: cetyltrimethylammonium bromide (CTAB), sodium dodecyl sulphate (SDS) and hydroxypropyl cellulose (HPC), which could be the promising carrier materials used as the implantable drug delivery systems. The xerogels were prepared by the sol-gel method. The influence of various formulation precursors on porosity parameters and drug release were investigated. Addition of surfactants showed a promising result in controlling the MT release. Dissolution study revealed increased release of MT from silica modified SDS and CTAB, whereas the release of MT from silica modified HPC considerably decreased, in comparison with unmodified silica. The addition of surfactants showed slight changes in porosity parameters. All xerogels are characterized by a highly developed surface area (701-642 m(2) g(-1)) and mesoporous structure. The correlation between pore size obtained matrices and release rate of drug was also observed. Based on the presented results of this study, it may be stated that applied xerogel matrices: pure silica and surfactants-modified silica could be promising candidates for the formulation in local delivery systems.

The sol-gel prepared SiO2-CaO-P2O5 composites doped with Metronidazole for application in local delivery systems

The aim of this study was to evaluate the physical properties, chemical structure and bioactivity of sol-gel processed oxide (SiO(2)-CaO-P(2)O(5)) composites used as controlled release materials for Metronidazole-drug applied in periodontal disease treatment. The obtained composite materials were characterized by Fourier transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), the Brunauer-Emmet-Teller (BET) technique and further monitoring in the ultraviolet and visible light regions (UV-Vis) of the in vitro release of the drug over time. Using tetramethoxysilane (TMOS) as a precursor of silica matrix and calcium nitrate tetrahydrate (Ca(NO(3))(2) 4H(2)O), triethyl phosphite (P(OC(2)H(5))(3)) as precursors of CaO and P(2)O(5) respectively, xerogels with different morphology and physical properties were obtained. The applied modifications improved also the bioactivity and changed the profile of the drug release. Based on the presented results of this study, it may be concluded that applied xerogel matrices could be promising candidates for the formulation in local delivery systems.

Dielectric relaxation study on tramadol monohydrate and its hydrochloride salt

Dielectric relaxation measurements as well as differential scanning calorimetry and X-ray diffraction investigations were performed on tramadol monohydrate and its hydrochloride salt. Examined samples do not crystallize during cooling and in consequence they reach the glassy state. In the case of the hydrochloride tramadol we are able to monitor alpha-relaxation process despite large contribution of dc conductivity to the loss spectra. It is the first such study on the salt of the drug. Up to now the dielectric spectroscopy has been regarded as useless in measuring such kind of API (active pharmaceutical ingredient). In this paper we also made some suggestions about the nature of the secondary relaxations in the amorphous tramadol monohydrate and its salt. The knowledge about the molecular mechanisms, which govern the observed secondary relaxations seems to be the key in predicting the stability of the amorphous form of the examined API. Finally additional dissolving measurements on the amorphous and crystal tramadol hydrochloride were performed. As a result we understood that dissolution properties of the amorphous form of the considered drug are comparable to those of crystalline one. However, we have found out that amorphous tramadol hydrochloride has greater ability to form tablets than its crystalline equivalent. This finding shows that amorphous drugs can be alternative even for the freely solved pharmaceuticals such as tramadol hydrochloride, because the former one has better ability to form tablets. It implies that during tabletting of the amorphous drugs there is no need to use any excipients and chemicals improving compaction properties of the API.

Study of the amorphous glibenclamide drug: analysis of the molecular dynamics of quenched and cryomilled material

Glibenclamide (GCM) is an oral hypoglycemic agent of the sulfonylurea group used in the treatment of non-insulin-dependent diabetes. Crystalline GCM is characterized by low bioavailability, which is attributed to its poor dissolution properties. It prompted us to prepare this drug in its amorphous form as a means to enhance its dissolution characteristics. Two different methods were used to convert crystalline GCM into the glassy form: quench-cooling of the melt and cryogenic milling. To monitor solid-state properties of the amorphous samples, X-ray powder diffraction (XRD), infrared spectroscopy (FT-IR), differential scanning calorimetry (DSC), ultraperformance liquid chromatography (UPLC) and spectroscopy, and broadband dielectric spectroscopy (BDS) were applied. The results of UPLC separations along with associated infrared and NMR measurements unambiguously showed that the thermal degradation of the quenched GCM, as suggested in literature reports, does not occur. A similar analysis performed on the cryomilled material also did not indicate any chemical decomposition. On the other hand, both methods confirmed that the conversion to the amorphous form is connected with the amide-imidic acid tautomerism of the examined drug. Moreover it was shown that this transformation occurs regardless of the manner of amorphization. Finally, dielectric spectroscopy was employed to study the molecular dynamics of vitrified GCM. The analysis of the ε''(f) in terms of the KWW function from the dielectric measurements revealed the existence of an "excess wing" attributed to the true Johari-Goldstein process based on Ngai's coupling model. The dielectric properties of GCM obtained in the amorphous form both by rapid cooling of the melt and the cryogenic grinding of crystalline sample were also compared.

Hot tabletting of slow-release tramadol hydrochloride microcapsules with cores obtained via compaction

BACKGROUND

Coating, as a processing technique, applied to active pharmaceutical ingredient (API) crystals or particles (carriers) with an appropriate polymer allows to obtain a modified-release pharmaceutical dosage form. Such carriers can be the basic ingredient of a multi-unit dosage form. Additionally, coated API crystals (microcapsules) can provide an alternative to spherical granulate (pellets) as the main and most commonly used component of multi-unit dosage forms. Coating individual API crystals is a complicated process because of the crystals having insufficient size (below 100 microm), irregular shape, low mechanical durability and the fact that API crystals dissolve upon contact with the coating mixture, and other factors.

METHOD

Compaction process was used to eliminate these inconveniences allowing us to obtain tramadol hydrochloride (TH) microcapsule cores in the size range of 212-500 microm. The coating of the cores was successfully conducted using a fluidized-bed coating technique with four different polymers that allowed us to attain slow release of TH. Then, the microcapsules were subjected to a hot tabletting process conducted by applying a low compression force of about 1 kN at 56 degrees C. Semi-liquid granules containing melted PEG 3000 combined with TH microcapsules were compressed. A tablet matrix of good physical parameters was created when its temperature decreased to room temperature. In the proposed hot tabletting method, PEG 3000 included in the granulate provided the tableted microcapsules sufficient protection against rupture.

RESULTS

The compaction process allowed us to eliminate unwanted physical API properties, which could otherwise have an adverse effect on the fluidized-bed coating process. The microcapsule cores after compaction and coating using a fluidized-bed coating technique showed a TH-release profile similar to that of the compressed microcapsules after applying hot tabletting process.

CONCLUSIONS

Multi-unit dosage forms can be obtained in a relatively simple way by combining three processes: (i) obtaining TH microcapsule cores by compaction, (ii) coating, and (iii) hot tabletting.

Influence of the components of Kollicoat SR film on mechanical properties of floating pellets from the point of view of tableting

The influence of pellet core ingredients on pellet behaviour, e.g. during compression, is well known. In this study the influence of components of a Kollicoat SR polymer film on mechanical properties was investigated. The aim of this study was to evaluate the influence of polymer film components on the mechanical properties of the pellet as a whole, from the point of view of tableting. Tablets should disintegrate into undeformed pellets floating in this environment for 5-6 h, releasing the model drug--verapamil hydrochloride--if possible in a controlled way. The usefulness of texture analysis and work of compression measurement was also evaluated. Kollicoat SR in the form of a 30D aqueous dispersion was chosen as the main component of the polymer film. Polyvinyl pyrrolidone K-30 as a pore former, and propylene glycol, triethyl citrate and dibutyl sebacate plasticisers were selected as typical additives. The influence of different thickness of polymer film on behaviour during stress was also evaluated. After coating the cores with a 20 microm Kollicoat SR dispersion film, an increase in mechanical strength, in comparison to the pellet core, was observed (2.74 to 3.34 mJ). Addition of porophor increased the work of compression by 50% to 5.1 mJ. The investigation of the influence of plasticiser on film properties proved that the kind of plasticiser used in the polymer film had no effect on the mechanical properties of the film or pellets. Only in the case of the film with triethyl citrate was no distinct of the pellet core found. Pellets coated both with films with triethyl citrate and with dibutyl sebacate, in contrast to pellets with a film coating with propylene glycol, showed a significant decrease of the dissolution rate of verapamil hydrochloride (20, 10 and 40% at 6 hours, respectively). It is possible to compress pellets with a 50 microm polymer film without affecting the dissolution rate, as was confirmed during release studies. When using Kollicoat SR the most appropriate plasticizer seems to be triethyl citrate, and in this case a change of behavior during compression analysis by texture analyzer was observed. But so relationship was found between the type of plasticizer and the work needed to obtain a given deformation.

Fast disintegrating tablets containing Rhodiola rosea L. extract

Tablets with 250 mg of Rhodiola rosea L. extract disintegrating in less than 10 min were developed. The influence of the extract content and type of fillers and disintegrants on disintegration time and tablet hardness was evaluated. Type of the filler and the extract/filler ratio but not the type of disintegrant determined fast disintegration of the tablets. It was demonstrated that the extract:filler ratio lower than 1:1.5 enables preparation of tablets with the required disintegration time. The tablets containing microcrystalline cellulose as a filler, povidone as a binder and crospovidone as a disintegrant were stable during 6 months storage at 25 degrees C/60% RH, however, due to the decrease of hardness they did not pass the stability test at 40 degrees C/75% RH.

Influence of the type of cellulose on properties of multi-unit target releasing in stomach dosage form with verapamil hydrochloride

Microcrystalline cellulose (MCC) and powdered cellulose (PC) are commonly used excipients for solid dosage forms e.g., pellets. The aim of this study was to compare the utility of the MCC and PC in the floating pellet cores comprising verapamil hydrochloride (VH) manufactured by extrusion and spheronization and influence on their physical properties like swelling, compressibility and VH release. It was found by scanning electron microscopy (SEM) investigation that porosity of surface of the pellets' cores increased with an increase of PC amount in composition. Differential scanning calorimetry (DSC) analysis indicated the lack of physicochemical interaction between PC and MCC either with VH or with any excipients in the pellet core. Formulation having the highest PC participation were characterized by the highest friability and compressibility and addition of MCC corresponded with a decrease of friability and compressibility. The results on pellets friability were not reflected by the results on the hardness test. It means that the PC contents growth contributes to the hardness growth. The swelling forces of physical mixture of powders containing PC and MCC was different and increased with increasing amount of PC in pellet's core. Pellets' cores were coated with Eudragit NE dispersion. It was found that VH release rate from coated pellets with higher amount of PC was considerably slower in comparison to the pellets containing highest MCC participation.

Influence of acrylic esters and methacyrlic esters on flotation of pellets and release rate of verapamil hydrochloride

Eudragit RL (ERL) and Eudragit RS (ERS) are biocompatible cationic copolymers, pH-independent and insoluble in aqueous environment. In this study drug delivery system consisting of a capsule filled with floating pellets with verapamil hydrochloride (VH) is proposed. The release of VH in the stomach results in better solubility in an acid gastric environment in vivo and may result in greater amount of the VH absorbed and its higher concentration in plasma. The scope of this study was to investigate the influence of ERL and ERS ratio on VH release in 0,1 M HCl from floating coating pellets. The stability of this film was also investigated. The ERL film is much more permeable than ERS, and an increase of ERL film thickness did not retard the release rate. The combination of ERL and ERS are forms of the sustained release film. It was a necessary to add the uncoated pellets, which constituted the initial dose. The start of flotation depends on permeability of polymeric film, and decreases with addition of ERS. There is no change in the start flotation time after 12 months under room condition (25 degrees C/60% RH). The drug delivery from uncoated pellets and pellets coated with ERL/ERS is stable after 12 months under room condition (25 degrees C/60% RH).

Compressibility of floating pellets with verapamil hydrochloride coated with dispersion Kollicoat SR 30 D

The purpose of this study was to work out a method of compression of floating pellets with verapamil hydrochloride (VH) in a dose of 40 mg. It was assumed that this form should reside in the stomach floating for several hours and gradually release the drug in a controlled way. Compression of pellets into tablets, being a modern technological process, is much more perfect than enclosing them in a hard gelatin capsule. Kollicoat SR 30 D was selected for coating. In experiments three plasticizers were examined-propylene glycol, triethyl citrate and dibuthyl sebecate (all at concentration of 10%). It was found that VH release from pellets coated by the films of the same thickness (70 microm), however, containing plasticizers is considerably different. Pellets were prepared by wet granulation of powder mixture, spheronization of the granulated mass and coating of the cores with a sustained release film. Two kinds of cellulose, microcrystalline and powdered, and sodium hydrocarbonate were the main components of pellet core. Proper pellet coating film thickness, ensuring obtaining desirable VH release profile and flotation effect, was defined. X compositions of tablets with pellets were examined in order to obtain formulation, from which VH release would mostly approximate pellets before compressing. The best formulation was evaluated taking into account the effect of compression force an tablet hardness and friability, and pellet agglomeration and flotation. Tablet cross-section photographs were taken confirming necessary coating film thickness preventing their deformation caused by compressing into tablets.

Outcome and prognostic factors in advanced Hodgkin's disease treated with high-dose chemotherapy and autologous stem cell transplantation: a study of 341 patients

BACKGROUND

The reported probability of survival of patients with Hodgkin's disease (HD) following high-dose chemotherapy with autologous stem cell transplantation (HDC/ASCT) is 35-65% at 5 years. The Polish Lymphoma Research Group investigated retrospectively prognostic factors for overall survival (OS) and event-free survival (EFS), and the risk of secondary malignancies in a large series of patients who underwent HDC/ASCT.

PATIENTS AND METHODS

The data of 341 consecutive patients treated in 10 centers from 1990 to 2002 were collected and analyzed.

RESULTS

The actuarial 5-year OS and EFS were 64% [95% confidence interval (CI) 57% to 71%] and 45% (95% CI 39% to 51%), respectively. In the multivariate model, unfavorable prognostic factors for EFS were less than partial response at the time of ASCT [relative risk (RR), 2.92 (95% CI 1.68-5.08); P<0.001] and three or more previous chemotherapy lines (RR, 2.16; 95% CI 1.42-3.30; P<0.001). These two factors were also associated with unfavorable OS (RR, 3.32; 95% CI 1.90-5.79; P<0.001 and RR, 2.34, 95% CI 1.51-3.64; P<0.001). Five-year cumulative risk of secondary malignancy was 8.4% (95% CI 2% to 13%) and the only identified risk factor was splenectomy (P=0.02).

CONCLUSIONS

HDC/ASCT should be considered early in the course of disease for patients with a response after standard therapy.

Preparation of floating pellets with verapamil hydrochloride

The aim of this paper is to prepare a floating drug formulation in a gelatin capsule filled with tens of pellets with verapamil hydrochloride (VH) in a dose of 40 mg. The better solubility of VH in an acidic environment of the stomach may result in a greater amount of the drug absorbed. Pellets were prepared by wet granulation of a powder mixture, spheronization of the granulated mass and coating of the cores with aqueous dispersions of polymethylmethacrylate. Sodium hydrocarbonate contained in pellet cores ensures the flotation effect. Proper rate of VH release from pellets was obtained by a coating film of 25-105 microm thickness. Pellets of 1.25-1.6 mm size with a film of 75-85 microm thickness of considerably constant rate released the whole dose of VH in 6 h. During that time the pellets floated on the surface of the receptor solution.

The value of ultrasonography in preoperative assessment of selected prognostic factors in endometrial cancer

OBJECTIVE

To determine the efficiency of transabdominal and transvaginal ultrasonography (TAS and TVS) in the assessment of myometrial invasion, cervical involvement, pelvic lymph nodes, adnexal and omental metastases (preoperative staging) of endometrial cancer.

METHODS

Transabdominal and transvaginal 2D, ultrasound were performed on 90 women to classify myometrial invasion, cervical involvement, pelvic lymph nodes and adnexal metastases in endometrial cancer. According to this 13 type E (invasion involving the endometrium), 41 type S (superficial, of less than 50% of myometrial infiltration), 36 type D (deep infiltration) and 22 cervical involvement were identified. There were 15 G1, 60 G2 and 15 G3 cases. Adnexal, omental and lymph-node metastases were found in 11, two and 15 cases, respectively. Endometrial cancer was diagnosed on the basis of dilatation and curettage. The degree of invasion was evaluated preoperatively. Ultrasonographic findings were compared to surgical staging and histopathology of the surgical specimen.

RESULTS

The median age of the 90 women was 63.3 +/- 12.3 years (range 32 to 86 years). The median thickness of malignant endometrium was 19.5 +/- 9.6 (range 7 to 54 mm). In type E the median thickness was 11.76 +/- 4.2, in type S 17.3 +/- 7.6, in type D 24.8 +/- 9.8 and in cases with cervical involvement 23.2 +/- 11 mm. Myometrial invasion evaluated by TVS was accurate in 76 of 90 cases (accuracy 84.4%). In type E sensitivity was 92.3%, specificity 87.0%, positive and negative predictive value, respectively, 63.1% and 98.6%. In type S these values were respectively: 78.0%, 93.9%, 91.4%, 80.0% and in type D--88.9%, 92.6%, 88.9% and 100.0%. Tumor extension to the cervix was properly assessed in 19 of 22 women in which it was present (sensitivity 86.4%, specificity 85.3%, positive predictive value 85.5%, negative predictive value 95.1%). Adnexal metastasis was correctly diagnosed in 8 of 11 cases in which it was present (sensitivity 72.7%, specificity 97.5%, positive predictive value 80%, negative predictive value 96.3%), and lymph-node metastasis in only 5 of 15 cases (sensitivity 33.3%, specificity 100%, positive predictive value 100%, negative predictive value 88.2%).

CONCLUSION

These results suggest that 2D TAS and TVS evaluation of endometrial cancer are reliable methods for preoperative assessment of selected prognostic factors, e.g. myometrial invasion, cervical involvement and adnexal metastases. However in assessing lymph-node metastases, TVS with its low sensitivity, did not provide additional information. Preoperative ultrasound examination should be speculated as an important tool in the establishment of different surgical choices which can be made after a correct pretreatment prognosis.

The effectiveness of hysteroscopic polypectomy in cases of female infertility

The authors, based on their own material, evaluated the value of hysteroscopic treatment of endometrial polyps in a group of infertile women. Polypectomy was performed in 25 patients using either endoscopic microscissors or electric loop. Follow-up hysteroscopy was performed after two months as an integral part of the treatment. All the patients were observed for 12 months. The primary intrauterine investigation was complete in all patients without regard to kind of instrument which was confirmed by second-look hysteroscopy. About 80% of the patients who underwent surgery conceived. Restoration of reproductive ability did not depend on the size of the removed lesion.

Hysteroscopy in cases of cervical polyps

To assess the usefulness of hysteroscopy in cases of cervical polyps, we studied 78 patients with a lesion found during a routine gynecological examination. All women were referred for diagnostic hysteroscopy followed by endoscopic polypectomy. In 83.3% of the cases intrauterine investigation confirmed primary diagnosis - a polyp peduncle in the cervical canal. Sixty-five of those lesions were the only pathologic condition, and six (7.7%) were associated with an endometrial polyp. In the remaining 16.7% of examined patients, primary polyps identified as cervical polyps appeared to be endometrial. All women admitted to the study were successfully treated by hysteroscopy. Our results suggest that endoscopic evaluation of the uterine cavity in women with cervical polyps can clarify the initial diagnosis. Hysteroscopy allows not only a precise visualisation of the polyp peduncle but also gives the possibility to identify and treat concurrent asymptomatic intrauterine pathological conditions.

The importance of fine needle aspiration biopsy and sonographic evaluation of parametria in cervical cancer

OBJECTIVE

The aim of study was to estimate of the value of fine needle aspiration biopsy (FNAB) and transvaginal ultrasonography (TVS) in the preoperative assessment of the parametria in cervical cancer. We compared parametrial infiltration before and postoperatively by histopathology to verified and confirmed staging of disease. Correct staging qualification, especially evaluation of the parametrium, is very useful in choosing an adequate method of treatment, and thereby in patient survival.

MATERIAL AND METHOD

52 women (median age 56 years, range 33-85) with cervical cancer in Stage Ib and 49 (median age 51, range 36-71) in Stage II and III, were included in the study. Assessment of parametrial invasion before treatment was performed by fine needle aspiration biopsy (FNAB) with endovaginal ultrasound assistance. The sonographic evaluation of parametria was performed by Siemens Sonoline Versa Pro with a transvaginal 7 MHz mechanical transducer with a biopsy guide and 21-gauge needle. The probe was covered with a disposable latex sheath filled with ultrasound gel. The aspirated material was placed on a glass slide, fixed in 95% alcohol and submitted to cytologic evaluation. All of the patients with cervical cancer in Stage Ib underwent a Wertheim-Meigs hysterectomy. The preoperative findings were compared with data obtained by histopathology findings. Moreover, in the whole group of 101 patients a comparison of FNAB and sonography was performed. The sensitivity, specificity and diagnostic accuracy of this method were evaluated.

RESULTS

Parametrial involvement assessed postoperatively by histopathology, in clinical Stage Ib cervical cancer was found in eight of 52 cases (15.4%). FNAB of parametrial involvement in the operated group was accurate in 14 of 18 (accuracy--83%, sensitivity--78%, specificity--84%, PPV--50%, NPV--95%). Sonographic assessment of parametrial involvement was correct in 12 of 18 cases (accuracy--58%, sensitivity--67%, specificity--56%, PPV--24%, NPV--89%). In the whole group of patients (operated and non-operated), sonographic evaluation of parametria verified by FNAB was correct in 104 of 202 cases (accuracy--78%, sensitivity--71%, specificity--86%, PPV--84%, NPV--74%).

CONCLUSIONS

FNAB and TVS assessment of the parametria are very useful methods in confirmation of neoplastic infiltration. Correct preoperative diagnosis may improve staging, treatment and indirectly, survival of patients with cervical cancer.

High-dose chemotherapy with autologous stem cell transplantation is an effective treatment of primary refractory Hodgkin's disease. Retrospective study of the Polish Lymphoma Research Group

We analysed the treatment outcome of primary refractory HD patients managed with high-dose chemotherapy and haematopoietic cell transplantation. Data of 65 adult patients who underwent HDC/ASCT in nine Polish centres for primary resistant Hodgkin's disease between June 1991 and July 2000 were collected retrospectively. Response rate to HDC/ASC: CR, 54%; PR, 20%; less than PR, 15%; early deaths, 11%. Actuarial 3-year OS and PFS were 55% and 36%, respectively. In multivariate analysis, lack of bulky lymph nodes and use of immunotherapy were favourable factors for both OS and PFS. IPF <3 at the time of transplantation was predictive for PFS. However, the prognostic impact of immunotherapy should be interpreted with caution since this group included more patients who achieved CR after HDC/ASCT. The results of HDC/ASCT are encouraging and confirm earlier findings. The role of immunotherapy should be further investigated in prospective trials.