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The place of high-dose BEAM therapy and autologous bone marrow
transplantation in poor-risk Hodgkin's disease. A single-center eight- year
study of 155 patients
R Chopra, AK McMillan, DC Linch, S Yuklea, G Taghipour, R Pearce, KG Patterson and AH Goldstone
Department of Haematology, University College and Middlesex School of
Medicine, London, UK.
Although high-dose chemotherapy and autologous bone marrow transplantation
(ABMT) are increasingly being used for the treatment of relapsed and
resistant Hodgkin's disease, there have been few large, single-center
studies reported with adequate follow-up to allow full evaluation of this
therapeutic modality. We present 155 poor-risk Hodgkin's disease patients
who received high-dose BEAM (BCNU, etoposide, cytosine arabinoside, and
melphalan) chemotherapy and ABMT who have been studied over a period of 8
years. All patients had either not attained a remission on mechlorethamine,
vincristine, procarbazine, prednisone-type therapy and had poor prognostic
features at presentation, not attained a complete remission or relapsed
within 1 year of an initial alternating regimen, or not attained remission
with two or more lines of treatment. At the time of ABMT the relapse status
of the patients was as follows: 46 patients were primarily refractory to
induction therapy, 7 were good partial responders, 52 were in first
relapse, 37 in second relapse, and 13 in third relapse. Seventy-eight
patients had chemoresistant disease, 33 had chemosensitive disease at the
time of ABMT, and 44 were untested for chemosensitivity at latest relapse.
The procedure related mortality in the first 90 days post-ABMT of 10%
overall. At 3 months 43 patients (28%) were assessed as complete
responders, 72 patients had a partial response (46%), and 24 patients (16%)
had no response or progression of disease. However, by 6 months, 53 (24%)
patients were assessed as complete responders and 51 (33%) patients had
nonprogressive disease. Forty-five patients had received radiotherapy
post-ABMT to residual masses (41 patients) or to previous sites of bulk
disease (4 patients). The actuarial overall and progression-free survival
at 5 years was 55% and 50%, respectively. On multivariate analysis patients
with bulk (masses > 10 cm), heavily pretreated patients (those receiving
three or more lines of treatment) and females had a significantly poorer
prognosis. Relapse status was also significant for progression-free
survival in that patients in second (60%) and third relapse (70%) had a
better prognosis than those in first relapse (44%) or with primary
refractory disease (33%). Response to prior chemotherapy did not predict
for progression-free survival. These results enable comparisons to be made
between high-dose chemotherapy with ABMT and conventional dose salvage
therapy. Furthermore, although the results as a whole are highly
encouraging, certain groups carry an unfavorable prognosis.
Volume 81,
Issue 5,
pp. 1137-1145,
03/01/1993
Copyright © 1993 by The American Society of Hematology
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