Autologous Bone Marrow Transplantation - Blog Science Connections

228 Chemotherapy and ABMT in Hodgkin s Disease
(16). Inferior results have been achieved by a recent multi-institutional German
study that randomized MOPP-resistant Hodgkin's disease patients to receive
either ABVD or a new four-drug regimen called DBVCy (daunorubicin,
bleomycin, vincristine, cyclophosphamide). The CR rate for patients treated
with ABVD was 11% compared with 24% for DBVCy therapy. The median
duration of response to both combinations was less than 5 months (17).
Another second-line salvage protocol is the B-CAVe (bleomycin, CCNG
[ lomustine ], Adriamycin [ doxorubicin J, vinblastine) tested at Stanford University
in 52 MOPP-resistant patients (18). Twenty-one out of 52 patients achieved a
CR, and 25% had 5 years' freedom from progression. For both ABVD and
B-CAVe protocols, the incidences of CR and disease-free survival were related to
absence of systemic symptoms and disease extent. Recently, Einhom et al. (19)
tested the new second-line protocol VABCD (vinblastine, Adriamycin [doxorubicin],
bleomycin, CCNU [lomustine], dacarbazine) in 18 MOPP-refractory
patients. Eight of 18 patients entered CR, and 5 of 8 responders maintained a
CR from 5 to 36 months (19).
An unresolved matter is the role of third-line combination chemotherapy in
the salvage of patients whose disease is refractory or who relapse soon after
treatment with MOPP and ABVD protocols. They are CEP (12), CAD (13), and
MIME (mitoguazone, ifosfamide, methotrexate, etoposide) (9). With these
protocols, the CR rate varied from 13% to 40%, and absence of extranodal
involvement was the only statistically significant factor predicting CR; in
addition, the use of third-line regimens may result in a 10% disease-free survival
1 year later (9,11). There is, however, a large group of patients with malignant
disease who do not achieve a remission or they relapse after a few months and
then respond poorly even to third-line chemotherapy protocols such as CEP,
CAD, or MIME.
The aim of our study, started more than 5 years ago, was to improve
salvage therapy results in patients with highly treated advanced Hodgkin's
disease by high-dose chemotherapy and ABMT rescue. From this pilot study,
we have shown that it was possible to achieve a high response rate (71.4%) after
high-dose chemotherapy with a very low proportion of early deaths in 28
patients who had resistant Hodgkin's disease with very poor prognosis. Similar
results have been obtained by others on similar patients. A recent review
reported that a total of 41 patients had been evaluated and that 21 (51%) had
achieved CR (14). Ten patients relapsed early and three died in remission.
Unfortunately, an assessment of disease-free survival in the nine patients still
alive and well is limited because of the short observation period (< 12 months).
However, there are four patients that have survived in CR 24-48 months.
Spitzer et al. (20) reported the results of high-dose chemotherapy in 33
adult patients with Hodgkin's disease whose disease failed to respond after
extensive prior chemotherapy and irradiation. Twenty-two patients (67%) had
progressive disease at their last salvage chemotherapy at transplantation, and
48% had extranodal disease. Among the 22 patients who had previously