Autologous Bone Marrow Transplantation - Blog Science Connections

322 Proposed International Adult Lymphoma Study
5. As shown in the figures named above, an early plateau was reached by
most of the patients who achieved continuous CR; therefore, no maintenance
therapy will be given after ABMT. Pre-ABMT involved-field radiotherapy
on an "iceberg" of initial localization of the relapses will be
recommended because 75% of the relapses are caused by recurrence of
local disease.
6. In the chemotherapy arm of this study and in order to avoid any delay in
the DHAP regimen timing, involved-field radiotherapy will be recommended
at the end of the program for patients whose disease is not progressing
(see Fig 10).
7. It is our intention that patients from our group or those referred to our
group at time of relapse (they should have reached CR previously) with
intermediate- or high-grade adult non-Hodgkin's lymphoma, first, will be
classified as being in RR or SR after two courses of DHAP; second, will be
randomized, if in SR, to a conventional rescue protocol or ABMT. Third,
this protocol will concern all adult patients with diffuse non-Hodgkin's
lymphoma who are in relapse. No case of Burkitt's lymphoma will be
included.
Chemotherapy Salvage Regimens
In 1981, based on prior experience with two ifosfamide-etoposide combinations
(one with methotrexate and the other with doxorubicin), MIME was
devised at The University of Texas M. D. Anderson Hospital and Tumor
Institute at Houston (8,9). Mitoguazone was included as part of the regimen
because of the encouraging results of two independent phase II studies
conducted by the Southwest Oncology Group and the Memorial Sloan-
Kettering Cancer Center (46,47). A major advantage of this drug is that it
does not cause myelosuppression and therefore can be combined at almost
full dose with other drugs.
MIME Results
Of the 208 patients in the U.T. M. D. Anderson Hospital MIME study, 206
had received treatment with doxorubicin-containing regimens. In order to
determine whether the MIME regimen could be cross-resistant with frontline
combination chemotherapies, the response to MIME was compared with
response to frontline therapy. Those who responded best to MIME were those
who had responded to frontline treatment but who had relapsed more than 6
months after the frontline therapy had been completed. The CR rate of those
who were only able to achieve PR on frontline therapy was low (12%), but the
overall response rate was 64%, with a 33% response rate in patients with
diffuse non-Hodgkin's lymphoma. Those who had responded but relapsed
while still undergoing active frontline therapy showed an intermediate response
rate. Patients whose disease had not responded to frontline therapy
had the lowest CR rate as well as the lowest overall response rate (10,48). We