autologous blood and marrow transplantation - Blog Science ...

Progressive Hodglcin's Lymphoma
Following High-Dose Chemotherapy
J. Shamash, S.M. Lee, W.D.J. Ryder, G.R. Mogenstern,
J.H. Scarffe, A.Z.S. Rohatiner, R.K. Gupta, T.A. Lister, J.A
High dose chemotherapy (HDCT) with autologous hematopoietic support is an
established treatment modality for relapsing and refractory Hodgkin's lymphoma.
In a series of 93 patients at two centers, 37 have progressed at a median of 7 months
following HDCT. Further treatment produced a "response" in 81% whose median
survival was 13 months. No response was seen in 19%, and in this group median
survival was 4 months. The therapies employed included local radiotherapy,
single-agent chemotherapy (usually vinblastine or lomustine), or multiagent
chemotherapy. Patients managed using a single sequential approach had a median
survival of 8 months, with vinblastine and local radiotherapy being most reliable in
producing a symptomatic response. Patients managed using multidrug
chemotherapy had a median survival of 13.5 months with a low-dose continuous
regimen comprising lomustine, chlorambucil, daily s.c. bleomycin, vinblastine, and
methotrexate employed on an 8-weekly schedule. The regimen was well tolerated
and appears efficacious. These results indicate the heterogeneity of management of
relapse after HDCT at two major centers and present some argument for a more
uniform approach.
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