High-dose chemotherapy with autologous bone marrow transplantation in 50 advanced resistant Hodgkin's disease patients: an Italian study group report.

Abstract

Fifty patients with recurrent Hodgkin's disease have been treated with high-dose therapy followed by autologous bone marrow transplantation. Forty-one patients had extranodal sites of relapse and 31 patients had constitutional symptoms. Two patients had been treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP), lomustine, vinblastine, procarbazine, and prednisone (CcVPP), and radiation; 16 patients with MOPP, doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), radiation, and lomustine, etoposide, and prednisone (CEP); 20 patients with alternating MOPP/ABVD, and 12 patients with alternating MOPP/ABVD followed by CEP and radiation. Eighteen patients had progressive disease during alternating MOPP/ABVD protocol alone or during conventional salvage therapy; 32 patients had had a complete remission with first-line therapy but later relapsed, 25 of them having received conventional salvage therapy; 12 achieved no response or progression ("resistant-relapse" patients); and 13 responded partially or completely ("sensitive-relapse" patients). Complete remission occurred in 24 patients (48%) with a median duration of 24 months and 16 patients (32%) achieved partial response with a median duration of 9 months, for an overall response rate of 80%. Ten patients failed to respond and died in progressive disease 1 to 10 months (median, 6 months) after transplantation. Toxicity was significant including infections (20%), liver enzymes and alkaline phosphatase elevations (100%), and carmustine lung toxicity (7%). There were two treatment-related deaths; one patient died of Pseudomonas aeruginosa septicemia and another patient died of cerebral hemorrhage. These results validate the procedure of high-dose therapy followed by autologous bone marrow transplantation in inducing remission in these advanced, highly-treated patients. Clearly, the question of whether high-dose therapy and transplantation will eventually supersede new conventional salvage therapies will be addressed after controlled clinical studies.

High-dose chemotherapy and autologous bone marrow transplant in relapsed Hodgkin's disease - a pragmatic prognostic index

“…Jones et al (1990) reported their series of 50 patients which included 21 patients treated with an allograft and found that a complete or partial remission at the time of transplant was not a significant prognastic factor, but the presence of sensitive disease at the time of transplantation was a favourable prognostic sign for surviving event-free. The efficacy of high-dose chemotherapy with bone marrow rescue has been shown to be greater when there is some degree of sensitivity to the therapy (Lohri et al, 1991;Carella et al, 1988;Jagannath et al, 1989) Lohri et al (1991) also reported a very strong negative impact on outcome in patients with stage IV disease at presentation, recurrence within a year of primary treatment or presence of B symptoms ar recurrence. We did not find any of these factors to be significant in our study as most have been employed to predict response to second line therapy whereas most of our patients were at different stages in their disease, usually much later when the duration of first response may not have been relevant.…”

Autologous stem cell transplantation for Hodgkin's disease: busulfan, melphalan and thiotepa compared to a radiation-based regimen

“…The Bu/Mel/T regimen evaluated in our study demonstrated a comparable efficacy to the TBI-based and non-TBI-based regimens previously reported. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]40,41 In the current series, patients with more advanced disease or had received prior DLRT, who had an outcome expected to be poor, had an EFS of 33 and 36% at 5 years, respectively, after the Bu/Mel/T regimen. It was not possible to directly compare the outcome of these patients to the TBI-based regimen since prior DLRT is generally an exclusion for TBI.…”

“…1 High-dose chemotherapy with or without radiation therapy supported with autologous stem cell transplantation (HDC/ASCT) is potentially curative for this subset of patients. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Total body irradiation (TBI) in combination with high-dose cyclophosphamide (CY) (TBI/ CY) 3,4 and etoposide (TBI/CY/E), 5,6 , and the combination of CY, carmustine and etoposide (CVB), 5,6,9,10,[12][13][14][15][16] carmustine, etoposide, cytosine arabinoside with either melphalan (BEAM) 18,19 or cyclophosphamide (BEAC) 20 constitute the most common high-dose regimens evaluated. The superiority of a specific regimen, however, has not been demonstrated.…”

Tandem transplant of peripheral blood stem cells for patients with poor-prognosis Hodgkins’s disease or non-Hodgkin’s lymphoma

“…The initial chemosensitivity to salvage chemotherapy remained the most important prognostic factor. [10][11][12] The proportion of patients salvaged by HDT ϩ ASCT reached 45-60% in patients with good prognostic features according to the prognostic model proposed by Vose et al 13 for NHL patients and by Brice et al 14 for those with HD. However, for patients with adverse prognostic factors, the probability of being cured decreases rapidly to under 40% with standard conditioning regimen and ASCT.…”