Autologous Bone Marrow Transplantation - Blog Science Connections

Panel Discussion: Session IIB 309
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DR. PHILIP: Then the reference of conventional chemotherapy is 15% at
4 years?
DR. CABANILLAS: Correct.
DR. F. BRITO-BABAPCILLE: Dr. Philip, the conventional way of staging
patients with Burkitt's lymphoma is to stage A, B, C, and D, depending on
whether they have abdominal or extra-abdominal disease. The reason for
doing this is because extra-abdominal disease has a good prognosis. Now
you stage them differently. Could I ask whether your group of patients who
did not respond had abdominal or extra-abdominal disease? And secondly, in
your review of your current treatment for Burkitt's lymphoma, 1 notice you
didn't mention the studies which you published in Blood in 1984, in which
you reported a complete remission of 80% in Burkitt's and other poorprognosis
large cell lymphomas.
DR. PHILIP: There are a lot of questions. The first one is to address the
lymphoma classification. There is a Ziegler classification (A, B, C, D), which is
commonly used in Africa but not in Europe and the United States. The
Murphy classification is generally used in the United States, and it considers
stage 111 as large abdominal masses, while stage IV is the same kind of tumor,
with bone marrow or CNS involvement. In my opinion, the Ziegler
classification is interesting. We published in the British Journal ofHaematology
that, within stage III, you can make the division between the good and
the bad stage III. The good one corresponds with Ziegler's stage C, the one
with only one abdominal mass, whereas the one with several masses, stage D,
has the bad prognosis of Murphy's stage 111. Secondly, it was not my objective
to make a complete review of the treatment of Burkitt's lymphoma. The
survival rate, which is 75%, has been published by several groups. The
difference between pediatric and adult Burkitt's lymphomas is not significant.
Therefore, the indication of bone marrow transplantation in Burkitt's
lymphoma is limited.
DR. CABANILLAS: We have time for one more question.
DR. A. HAGENBEEK: I would like to ask something about the message
delivered by Dr. Philip on the intensive induction chemotherapy regimens in
intermediate- and high-grade lymphomas. It might be of interest to those of
you who are not aware of those data that since 1982, Bonadonna has been
running a randomized prospective trial in patients with high-grade lymphomas
(stages III and IV) comparing conventional CHOP with ProMACE. The studies
have been going on now for 4 years and there is not one single difference,
neither in remission rate nor in disease-free survival.
DR. CABANILLAS: Thank you. I think we are going to end this session
and go on to the next one, which will be chaired by Drs. Philip and Spitzer.