Autologous Bone Marrow Transplantation - Blog Science Connections

304 Treatment Strategies for NHL
alternative regimen, and three of the complete responders received high-dose
chemotherapy and ABMT. This procedure may be of interest in PR patients,
even after relatively intensive initial treatment. Second, 88% of the responding
patients (those with CRs or PRs) finally attain CR and remain disease free with a
median follow-up of 14 months. If 20% relapse (accepted rate), a long-term
survival rate of around 70% is to be expected. Third, only PRD patients carried a
poor prognosis, and most of them were more than 65 years old. Apparently
patients of this disease status and age cannot tolerate a full-dose regimen to
obtain good response.
CONCLUSIONS AND TREATMENT STRATEGIES
1. Intensive induction therapy probably improves survival in advanced
aggressive non-Hodgkin's lymphoma.
2. For at least 50% of the patients, exposure to relatively toxic initial therapy is
not necessary to achieve long-term survival.
3. Patients with poor prognosis should be selected early according to response
to initial therapy.
4. High-dose chemotherapy with ABMT as consolidation of first CR after
intensive initial treatment is difficult to justify.
5. High-dose chemotherapy with ABMT is promising as salvage treatment for
those with PRs and those in relapse. Its value in comparison with conventional-dose
salvage regimens remains to be investigated.
With the above conclusions in mind, two possible strategies for advanced
aggressive non-Hodgkin's lymphoma can be discussed. First, consider a
strategy dominated by intensive initial treatment in which a significant number
of patients will be lost to toxicity or suffer high treatment-related morbidity. The
better results of those regimens should be confirmed by randomized studies.
The possibility of salvage after PR or relapse in this strategy is probably limited
but remains to be investigated. Second, consider a strategy dominated by the
increased possibilities of salvaging patients who had PR or relapsed after a less
toxic traditional first-line treatment (Fig 3). Most patients in PR and up to 40% of
TRADITIONAL
FIRST-LINE
REGIMEN
HDCT/ABMT CONVENTIONAL DOSE
Figure 3. Flow chart of possible outcomes after traditional first-line therapy (CR, complete
remission; PR, partial remission; PRD, progressive refractory disease; CCR, continuous
complete remission; HDCT/ABMT, high-dose chemotherapy and autologous bone
marrow transplantation).