High-dose chemotherapy and autologous hematopoietic stem cell transplantation: the lymphoma experience and its potential relevance to solid tumors.
Lymphomas, which are frequently subdivided into Hodgkin's disease and non-Hodgkin's lymphoma, represent one of the more curable cancers that present as a solid tumor. Unfortunately, most patients cannot be cured with conventional chemotherapy, therefore new techniques have been developed including high-dose chemotherapy and autotransplantation. Non-Hodgkin's lymphoma was one of the first illnesses to be tested using the new methods and initial encouraging results in relapsed lymphoma led to the testing of high-dose chemotherapy with autotransplantation as a primary therapy for patients with lymphomas. Encouraging results have been obtained in several randomized trials. Studies of the treatment of lymphoma have identified several principles related to the application of autotransplantation, which may be relevant to other solid tumors. Autotransplantation is likely to be of benefit only when using active chemotherapeutic agents that can be escalated in dose and when myelosuppression is the dose-limiting toxicity. Chemotherapy-responsive tumors are obvious targets for autotransplantation, whereas chemotherapy-resistant tumors are unlikely to benefit. Other factors that should be taken into account when selecting patients for high-dose chemotherapy regimens include the extent of disease, preceding therapy and the performance status of the patient.
Armitage
J O
JO
University of Nebraska Medical Center, Omaha, NE 68198-3332, USA.
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D008223:Lymphoma / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D009369:Neoplasms / Q000628:therapy*; D010865:Pilot Projects; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome