Vinorelbine, a semisynthetic alkaloid, has shown marked clinical activity in HD. The mechanism of action of VRB is similar to that of other vinca alkaloids causing inhibition of microtubule formation. However, the degree of neurotoxicity with VRB is less than with vinca alkaloids. Maximum-tolerated dose range is from 30-35 mg/m2/wk. VRB has limited severe toxicities. However, granulocytopenia (grade 3 or 4) is common in 60% of patients. A pilot study is under way to evaluate IF/VRB as a novel reinduction regimen for patients with relapsed or refractory HD before stem cell transplantation. Acceptable hematologic toxicity and acceptable stem cell mobilization rates are realized. The overall response rate is 80% (40% CR and 40% PR). Table 15-19 shows a regimen of IF and VRB therapy in relapsed or refractory HD.
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