Autologous bone marrow transplantation for patients with relapsed Hodgkin's disease

Hodgkin's disease is often curable with radiotherapy and chemotherapy, and cure may even be possible after the failure of an initial chemotherapy regimen. However, a poor prognosis awaits patients with early relapse after complete remission; those who do not achieve remission with chemotherapy; and those who do not achieve remission even after more than one chemotherapy regimen. Autologous bone marrow transplantation (ABMT), a procedure in which previously removed and stored bone marrow is reinfused into a patient after extremely high doses of chemotherapy are given, is successful for treating many malignancies, but is often withheld until late in the course of Hodgkin's disease. To determine the optimal time for ABMT in relapsed Hodgkin's disease, 70 patients were studied who underwent this procedure after chemotherapy treatment with high-dose cyclophosphamide, carmustine, and etoposide. All patients had been treated with at least one previous chemotherapy regimen, and 29 had been treated with 3 or more. Forty percent of the patients had received radiotherapy as part of their initial treatment. Results showed that 59 percent of the patients who underwent ABMT achieved a complete remission; 11 percent responded partially; 19 percent did not respond; and 11 percent died. The 4-year disease-free survival was approximately 27 percent, and 4-year survival was approximately 47 percent. Patients treated earlier in the course of the disease fared significantly better than those in whom several chemotherapy regimens failed. High-dose chemotherapy plus ABMT appears more effective than salvage chemotherapy (another regimen begun after failure) for patients with relapsed Hodgkin's disease. This treatment should be carried out as soon as possible after relapse. (Consumer Summary produced by Reliance Medical Information, Inc.)