Autologous Bone Marrow Transplantation - Blog Science Connections

318 Proposed International Adult Lymphoma Study
Table 1. Treatment Response
Complete Tumor Complete
Classi­
No. of
Response
Remission
fication Patients No. % No. %
NRR 16 13 81 9 56
RR 23 4 17 4 17
Total 39 17 44 13 33
Source: J. Armitage et al. and G. Spitzer et al., 1985, unpublished data.
Note: Investigators compared these two groups (those in nonresistant relapse with
those in resistant relapse) on complete tumor response (Yates x = 13.22; P < .002) and
complete remission (Yates x = 4.82; P = .03).
Abbreviations: NRR, nonresistant relapse; RR, resistant relapse.
The actuarial 2-year disease-free survival for the entire group was 20%,
with the last death at 31 months (median observation time, 33 months) (Fig
7). Disease-free survival was significantly related to previous response to
chemotherapy. The 2-year disease-free survival was 14% in the RR group and
38% in the SR group (Fig 8). Patients who never achieved CR would not
survive 2 years. Patients who had achieved a CR in initial chemotherapy had a
superior disease-free survival rate after ABMT when compared with patients
who never achieved CR (Fig 9). Patients with SR had a better disease-free
survival rate than did patients with RR. Outcome was not affected by
treatment regimen or histological grade. Whether relapse occurred on or off
therapy was also not of significance, but the probability of being in SR was
significantly higher for those who relapsed while off therapy. In conclusion, it
appears that prior response to chemotherapy is an important prognostic
variable in patients with intermediate- or high-grade non-Hodgkin's lymphoma
undergoing ABMT. These results explain why patients with RR or no
previous CR must be excluded from the randomized study.
The question of whether cures can be obtained with conventional
salvage regimens without ABMT remains unanswered. There are reports of
occasional long-term survivors after relapses treated with MIME (mitoguazone,
ifosfamide, methotrexate, etoposide) or DHAP (7-10; W. S.
Velasquez, M.D., 1986, personal communication). A randomized study is
now urgently needed to compare both treatment modalities. Several
conclusions can, however, be drawn from the literature.
The response rate of high-dose therapy and ABMT (72% of patients with
CR or PR) in the group of patients who never achieved CR and whose disease
is progressing on salvage therapy is a clear argument in favor of the doseeffect
relationship in non-Hodgkin's lymphoma and in favor of investigating
ABMT procedures (6,11). The significantly better survival rate for patients
still responding to conventional rescue prior to ABMT raises the possibility