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Treatment of progressive Hodgkin's disease with intensive chemoradiotherapy
and autologous bone marrow transplantation
GL Phillips, SN Wolff, RH Herzig, HM Lazarus, JW Fay, HS Lin, DC Shina, GP Glasgow, RC Griffith and CW Lamb
Division of Hematology, Washington University, St. Louis.
Twenty-six patients with progressive Hodgkin's disease after conventional
chemotherapy received intensive chemoradiotherapy and autologous bone
marrow transplantation (ABMT); 19 also received additional involved-field
radiotherapy. Twenty-one patients [81%, 95% confidence intervals (CI) 61%
to 94%] attained complete (n = 18) or partial responses. Ten patients (38%,
95% CI 20% to 59%) are disease- free a median of 4.5 years later (range 3.5
to 7.0 years), including seven patients with continuous complete responses.
The likelihood of overall response was not significantly influenced by any
clinical or treatment variable examined. However, there was a trend
favoring patients with higher Karnofsky scores, and higher scores were
associated with attainment of complete responses (P = .06 and P = .02,
respectively, Mann-Whitney U test). Both higher Karnofsky scores and
shorter durations of disease before transplantation were associated with
improved survival in a stepwise Cox multivariate analysis. The chief cause
of failure was progression at sites previously involved with Hodgkin's
disease. No patient relapsed in the marrow, and two of three patients with
a history of marrow involvement with Hodgkin's disease achieved durable
complete responses after transplantation. These data suggest that
inadequate pretransplant conditioning, and not the reinoculation of occult
tumor cells in the autologous marrow, caused most relapses. Fatal
treatment-related toxicity occurred in six patients. Three patients died of
idiopathic interstitial pneumonitis; each had previously received local
mediastinal irradiation before intensive chemoradiotherapy. Intensive
chemoradiotherapy and ABMT produces durable responses in some patients with
Hodgkin's disease incurable with conventional therapy. Use of such
therapies at the first sign of failure with conventional chemotherapy and
development of more effective conditioning regimens should further improve
results.
Volume 73,
Issue 8,
pp. 2086-2092,
06/01/1989
Copyright © 1989 by The American Society of Hematology
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