Early autologous bone marrow transplantation (ABMT) in the treatment of Hodgkin's disease.
The use of ABMT "early" in Hodgkin's disease (HD) could refer to its to its application at diagnosis, as part of primary therapy or even at the first evidence of disease progression after primary therapy. We have recommended intensive therapy and ABMT to HD patients at the time of first relapse after a complete remission induced by primary chemotherapy. Among the 58 patients entering transplant protocols at the time of first relapse, the majority first received several cycles of conventional chemotherapy and/or local radiotherapy prior to hospitalization for conditioning and autotransplantation. However, all 58 were subsequently conditioned with high-dose cyclophosphamide, BCNU and VP 16-213 +/- cisplatin (CBV +/- P) and autologous transplantation. The progression free survival (PFS) after transplantation was 61% (95% confidence intervals [C.I.] 43%-74%) at a median follow-up of 3.6 (range 1.6-8.2) years. Two patients died of toxicity within the first 5 months of ABMT, while 3 late deaths occurred > 1 year post-transplant. The probability of progression was 28% (95% C.I. 17%-43%). Multivariate analysis identified 3 adverse risk factors for PFS-B symptoms at relapse, initial remission duration < 1 year and extranodal disease at relapse. PFS was significantly correlated with the number of adverse factors. Patients with 2 or 3 risk factors are candidates for more intensive or innovative measures due to the high relapse rate seen in these subgroups. Patients with 0 or 1 risk factors have a < 15% probability of relapse post-transplant, and are arguably candidates for less aggressive regimens.
Reece
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Division of Hematology, Vancouver Hospital, British Columbia.
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014182:Transplantation, Autologous