Autologous Bone Marrow Transplantation - Blog Science Connections

218 CBV and ABMT in Hodgkin s Disease
PATIENTS AND METHODS
Sixty-two patients with relapsed Hodgkin's disease were treated with
high-dose chemotherapy and autologous bone marrow transplantation
(ABMT) at two referral institutions. Informed consent for participating in the
study was obtained from each patient.
The median age was 28 years (range, 15-56 years). There were 36
males. The median time from diagnosis to transplantation was 31 months
(range, 6-111 months). The performance status in Zubrod's scale was 0 (36
patients), 1(18 patients), and 2 or 3 (8 patients). Mo patient had major organ
failure at the time of entry in the study. The median number of previous
chemotherapy regimens patients had failed was two (range, 1 -5 regimens).
All but three patients had received both a MOPP-like regimen and a
doxorubicin-containing program. Twenty-nine patients had received an
etoposide-containing combination chemotherapy.
Twenty-four patients had not achieved a complete remission (CR) from
the initial chemotherapy with or without additional radiation therapy. Thirtythree
patients were progressing on the last salvage therapy. Forty-one
patients had previous radiation therapy.
The preparative regimen was CBV (4). The total dose of etoposide was
450 mg/m in the first patient; the dose was escalated to 600 2 mg/m in 21
2
patients, 750 mg/m 2 in 19 patients and, finally, 900 mg/m 2 in 21 patients.
ABMT was performed on day 7. One patient with bone marrow disease had
received marrow from a human leukocyte antigen matched and mixed
lymphocyte culture nonreactive sibling. Further details on chemotherapy
administration and treatment of Hodgkin's disease have been previously
reported (4,5).
RESULTS
The overall survival for all 62 patients with relapsed Hodgkin's disease
treated with CBV and ABMT is shown in Figure 1. The median survival is 26
months, with 33 patients alive at the time of this analysis.
Sixty patients had measurable disease at the time of high-dose chemotherapy,
while two were intensified in third complete remission (CR3). Twentyseven
(45%) of the 60 patients went into CR, while 15 (25%) achieved a
partial remission (PR). Six patients in PR received additional radiation therapy
and have achieved CR; five of these remissions were durable at 12+, 12+, 13+,
26+, and 31+ months. Eight of the 27 patients in CR and one of the two
patients intensified in CR3 have relapsed. One patient died of cytomegalovirus
and Pneumocystis carinii pneumonia 5 months after bone marrow
transplantation while still in remission, as shown by the autopsy. Figure 2
shows the disease-free survival for all 62 patients. Twenty-four patients are
alive and free of disease with a median follow-up time of 19 months.
Patients who achieve a complete response have an 85% projected 2-year