Summary:Although patients with relapsed Hodgkin's disease have a poor prognosis with conventional therapies, high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autotransplantation) may provide long-term progression-free survival. We reviewed data from the Autologous Blood and Marrow Transplant Registry (ABMTR) to determine relapse, disease-free survival, overall survival, and prognostic factors in this group of patients. Detailed records from the ABMTR on 414 patients with Hodgkin's disease in first relapse (n = 295) or second complete remission (CR) (n = 119) receiving an autotransplant from 1989 to 1995 were reviewed. Median age was 29 (range, 7-64) years. Median time from diagnosis to relapse was 18 (range, 6-219) months; median time from relapse to transplant was 5 (range, Ͻ1-215) months. Most patients received high-dose chemotherapy without total body irradiation for conditioning (n = 370). The most frequently used high-dose regimen was cyclophosphamide, BCNU, VP-16 (CBV) (n = 240). The graft consisted of bone marrow (n = 246), blood stem cells (n = 112), or both (n = 56).

The optimal timing in which to use intensive chemotherapy and autologous bone marrow transplantation (BMT) in Hodgkin's disease (HD) is uncertain. In 1985, we initiated a program in which this modality was used as the initial salvage therapy in patients relapsing after combination chemotherapy. Fifty-eight patients with HD in first relapse after primary chemotherapy received conditioning with high-dose cyclophosphamide, carmustine, etoposide (VP16–213) +/- cisplatin (CBV +/- P) followed by autologous BMT. All but six of these patients were given a median of two cycles of conventional chemotherapy +/- involved field radiation therapy before CBV +/- P and autologous BMT. These measures were not used as a means for patients selection; all patients receiving such therapy ultimately were transplanted. The probability of nonrelapse mortality, progression of HD, and progression-free survival post-BMT were calculated, and prognostic factors for progression-free survival were evaluated using the Cox proportional hazards method. Treatment-related deaths occurred in only three patients. Thirteen patients have relapsed at a median 0.7 years (range 0.1 to 3.5) post- BMT. At a median follow-up of 2.3 years (range 0.4 to 7.2), the actuarial progression-free survival is 64% (95% confidence interval, 46% to 78%). In the statistical analysis, three similarly weighted but independent prognostic factors were identified: “B” symptoms at relapse, extranodal disease at relapse, and initial remission duration of less than 1 year. Patients with no risk factors had a 3-year progression-free survival of 100%, compared with 81% in patients with one factor, 40% in those with two factors, and 0% in patients with all three factors. CBV +/- P and autologous BMT is highly effective salvage therapy for HD patients in a first relapse, particularly in the subset of patients with less than two adverse factors. Therapy must be improved in the future for patients with > or = 2 adverse factors.

Summary:Twenty-six patients with low-grade lymphoma (LGL) (n ‫؍‬ 18) or chronic lymphocytic leukemia (CLL) (n ‫؍‬ 8) received allogeneic BMTs between 1985 and 1998. Median age was 42 years, median interval from diagnosis to transplant 22 months and median number of prior treatments three. Twenty (77%) had stage IV disease; 22 (85%) had never achieved CR. Donor source was HLA matched sibling (n ‫؍‬ 19, 73%), matched unrelated (n ‫؍‬ 6, 23%) or syngeneic (n ‫؍‬ 1). Conditioning therapy included total body irradiation in 23 patients and busulphan in three. Twenty-five received GVHD prophylaxis with cyclosporine A; ؉ methotrexate (n ‫؍‬ 19), ؉ methylprednisolone (n ‫؍‬ 2) or ؉ T cell depletion of allograft ؎ methotrexate (n ‫؍‬ 4). Sixteen patients are alive, a median of 2.4 years post BMT. Death occurred due to transplant complications (n ‫؍‬ 7) or underlying disease (n ‫؍‬ 3). Eighteen (12 LGL, six CLL) of 22 evaluable patients (82%) achieved CR post BMT. Cumulative incidence of refractory/recurrent disease was 18% (95% confidence interval (CI) 7-42%). Overall and event-free survivals were 58% (95% CI 35-75%) and 54% (95% CI 32-72%), respectively. Allogeneic BMT for young patients with advanced LGL or CLL is feasible and can result in long-term disease-free survival. Bone Marrow Transplantation (2000) 25, 605-612. Keywords: low-grade lymphoma; chronic lymphocytic leukemia; allogeneic bone marrow transplantation Low-grade lymphoma (LGL) and chronic lymphocytic leukemia (CLL) are indolent hematologic malignancies with median survival times approaching a decade.1-5 Although clinical remission can be achieved with standard 6-9 and newer 10-14 therapies, prolonged freedom from recurrence has not been demonstrated for patients with advanced stage, making death from disease almost inevitable. 8,9,11,[13][14][15][16] for younger patients, particularly those with refractory or recurrent disease, a more aggressive approach to treatment can be justified. 17-20High-dose therapy with allogeneic stem cell support is an attractive option for such patients, where marrow involvement is common and the occurrence of a graftversus-leukemia/lymphoma (GVL) effect 21-26 may contribute to the achievement of long-term disease control. Worldwide experience with allogeneic transplantation in this setting is, however, still limited. We report results from 26 patients with LGL or CLL receiving allogeneic BMT at the Vancouver General Hospital since 1985. Patients and methods PatientsTwenty-six patients with LGL (n ϭ 18) or CLL (n ϭ 8) received allogeneic BMT between September 1985 and January 1998, during which time, a total of 589 allografts and 512 autografts were performed in adults by the Leukemia/BMT Program of British Columbia. Eligibility criteria included: (1) age р50-55 years (related donor) and р45-50 years (unrelated donor); (2) Karnofsky performance score (KPS) у80%; and (3) adequate pre-transplant organ function including left ventricular ejection fraction у40%, forced expiratory volume in 1 s у60% and diffusing capacity for car...