Autologous Bone Marrow Transplantation - Blog Science Connections

220 CBV and ABMT in Hodgkin s Disease
survival rate, while patients achieving a partial response have a median
survival of 16 months, and unresponsive patients, a median of 3 months.
Toxicity
Four patients who died of toxic reactions received a dose of etoposide
(900 mg/m 2 ). Other toxic reactions encountered were as follows: Nausea
and vomiting were seen in 83% of the patients following administration of
carmustine on the first day but were usually well controlled with antiemetics
during the subsequent days of chemotherapy administration. Hematuria
requiring blood product support occurred in less than 20% of the patients.
Almost all patients had febrile episodes during neutropenia that required
intravenous antibiotic therapy. Ten patients had radiographic evidence of
pneumonia and 16 patients had bacteremia during the neutropenic period.
Three patients had diffuse gallium uptake by the lungs noted at 1 month
posttransplantation, which resolved within a couple of months. Clinical
evidence of pulmonary fibrosis was not seen in any patient. One patient had
congestive heart failure requiring diuretics, digoxin, and after-load reducing
agents.
High-dose CBV chemotherapy produced significant neutropenia and
thrombocytopenia. One engraftment failed. This patient had autologous
marrow collected before her marrow relapse at the time of transplantation.
DISCUSSION
High-dose CBV and ABMT induced CR in 45% of the patients who had
persistent or relapsed Hodgkin's disease after receiving a MOPP-like regimen
and a doxorubicin-based program; 75% of these CRs are durable from 1 to 5+
years. These results confirm the preliminary data of the 30 patients reported
previously (4,5).
Hodgkin's disease is a highly responsive tumor to both chemotherapy
and radiation therapy. Patients who relapse after both MOPP- and ABVD-like
regimens still respond to third-line salvage chemotherapy, like CAD (CCNCI
[lomustine], melphalan, desacetylvinblastine amide [vindesine]) (6), CEP
(lomustine, etoposide, prednimustine) (7), or MIME (mitoguazone, ifosfamide,
methotrexate, etoposide) (8); however, the remissions are not durable.
Several investigators have tried high-dose chemotherapy and ABMT
(9-18). With the dose escalation, an increase in the CR rate and durability of
remissions has been noted. Most patients with relapsed Hodgkin's disease
have had radiation therapy and drugs with known pulmonary toxicity, such as
bleomycin, before high-dose therapy. Therefore, programs based on total
body irradiation have had higher incidences of treatment-related deaths
(12,14,18).
In conclusion, high-dose CBV and ABMT should be considered an