Autologous Bone Marrow Transplantation - Blog Science Connections

308 Panel Discussion: Session IIB
melphalan-type regimens, we found that the duration of prior unresponsiveness
was the most important variable. Factors that were very important, such
as very unfavorable DNA and RNA features, became less significant, so we
had sufficient evidence that these two regimens were non-cross-resistant and
that is why we are combining them now.
DR. D. BciCKNER: I would like to ask Dr. S. Gulati a question about the
patients in first relapse whom he performed transplants on. Were these truly
first-relapse patients? Did you try to induce a second remission? Because
that's really in variance with our results, we found that early relapse in
lymphoma, acute myelogenous leukemia, and other diseases a favorable
time for transplantation.
DR. S. GULATI: Yes, initially we would take any relapse and the first three
or four patients with bulky disease would receive transplants. Subsequently,
and especially now, we have a revised protocol in which we try to control the
disease by other combination chemotherapies. So, for example, if a patient
comes to us after an unsuccessful regimen of CHOP we try to reinduce him
with other combination chemotherapies before we perform a transplant. By
performing the transplant upfront, the success rate is 10-15%. When given
upfront, we feel that two transplants might be necessary. Using the same
regimen after reinduction, the success rate is 30-40%. The numbers are too
small to draw definite conclusions.
DR. G. CORNWELL: Dr. Barlogie, of the five patients you have treated
with the most aggressive therapy, you had three who were partial responders.
Has there been enough time to see what those three patients are going to do
with their disease?
DR. BARLOGIE: The one patient who had 30% plasma cells and the
elderly gentleman with 6-8% plasma cells both continue to show a progressive
decline in the myeloprotein. This is hovering around 0.3-0.7 g% and
the hemoglobin continues to rise gradually but continuously. They are not in
complete remission. The only complete remissions were observed in conjunction
with allogeneic transplantation.
DR. T. PHILIP: A question for you, Dr. Cabanillas. You have 52 patients
who have lymphoma and are being treated with DHAP, and you report a
disease-free 2-year survival rate of 15%. Is this 15% of the patients who
achieved complete remission or of the total 52 patients?
DR. F. CABANILLAS: That is 15% of the group of patients who had the
favorable characteristics that I showed: no bone marrow involvement, less
than 60 years old and having had a prior complete response to frontline
therapy. So those are patients who are relatively similar to the ones who will
have autologous bone marrow transplantations; that is the reason they were
selected. So that is 15% of the whole group of patients.