Autologous Bone Marrow Transplantation - Blog Science Connections

Panel Discussion: Session IIA 239
DR. VRIESENDORP: Dr. Jagannath, I was wondering, when you looked at
your factors, which predicted the outcome of transplantation in Hodgkin's
disease, whether you looked at the effect of bulky disease? The reason I ask is
because we've looked at our patients with Hodgkin's disease and, like you, we
haven't found that their initial response to chemotherapy predicted for
response if you took into account bulky disease. We've done 10 patients now
without bulky disease and of the 10, 7 are alive and disease free. Median
follow-up was around 1 year. Our results of non-Hodgkin's disease are similar.
DR. JAGANNATH: Yes, tumor burden at the time of transplantation is one of
the factors looked into. These patients who are treated with CBV and tumor
burden are of importance. The tumor burden definition is a bit complicated.
Any patient who had more than a 5-cm tumor bulk on any one side or a patient
who had extensive abdominal disease (i.e., simultaneous involvement of paraaortic
and pelvic disease or any involvement of mediastinum, even if not huge)
was prone to have a poor prognosis by this treatment, which was very
significant. Patients with mediastinal involvement, whatever size at the time of
transplant, had prior radiation therapy to the mediastinum, therefore, patients
who had mediastinum disease have a somewhat poorer prognosis.
DR. J. CAHN: Did you find any difference in terms of response rate in
patients who had relapsed in previously irradiated fields?
DR. JAGANNATH: Involved-field relapses are not significant.
DR. WOLFF: Hodgkin's disease is a notoriously indolent disease in which
patients can remain alive for prolonged periods of time with active illness, and 1
think that to critically evaluate the effect of a regimen, you have to look at
event-free survival and not just the overall survival.
DR. HAGEMEISTER: Steve (Dr. Wolff), you can estimate that about 70% of
the complete responders, which were about half the patients, stay well. So you
can anticipate it's going to be about 30%.
DR. D. HEARD: I may have missed these comments earlier, but I just
wanted to say something about peripheral blood stem cells in Hodgkin's
disease. We have now done a couple of patients and clearly, the marrow
involvement by Hodgkin's disease should not be a contraindication of going
ahead and doing these patients. Repeated leukaphereses and storage of
peripheral blood stem cells certainly lead to rapid engraftment following the
CBV therapy. As a matter of fact, patients reconstituted with peripheral stem
cells leave the hospital generally around 3V£ weeks, when the average time of
hospitalization for the marrow patients has been closer to 5 weeks.
DR. ARMITAGE: That also has been our experience, a much more rapid
recovery.
DR. T. PHILIP: Dr. Carella, can you comment on the toxicity of CBV1
versus CBV2 and, specifically, about toxic deaths in both of your protocols?