Hematopoietic stem-cell transplantation for Hodgkin's disease (HD): current status.
Not all patients with Hodgkin's disease (HD) respond to standard chemotherapy and/or radiation, and hematopoietic stem-cell transplantation has been gaining increasing acceptance in the management of HD. Phase II and, to a lesser extent, phase III studies of high-dose chemotherapy and autologous stem cell transplantation carried out at multiple institutions worldwide have proven the feasibility of the procedure and provided extended progression-free survival (and possibly cure) in a sizable number of patients with relapsed or refractory HD. Prognostic factors have been identified by multiple investigators (with response to chemotherapy being the most impressive one) and may ultimately allow a risk-adapted strategy. While early and late treatment-related morbidity and mortality remains an issue, with current supportive care modalities most patients tolerate this procedure with only minor or manageable complications. Disease recurrence remains a problem in many patients, and this can unfortunately occur as late as six or seven years after a seemingly successful transplant. New chemotherapeutic agents and strategies (such as post-transplant maintenance and possibly immunomodulation) will be required to successfully tackle this issue. Allogeneic stem-cell transplantation from HLA-compatible donors has yielded largely unsatisfactory results in the published studies in the literature, despite favorable results in a small minority of patients. Recently, however, newer approaches and strategies (such as the introduction of reduced-intensity, purine analog-based conditioning regimens and possibly cellular immunotherapy in the form of donor lymphocyte infusions) have provided very encouraging early results and seem to brighten the outlook for this procedure.
Department of Blood and Marrow Transplantation, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4095, USA.
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Anderlini
D017326:Clinical Trials, Phase III as Topic; D018572:Disease-Free Survival; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous