autologous blood and marrow transplantation - Blog Science ...

142 Chapter 4: Lymphoma
Table 2. Treatment features of 100 patients undergoing autologous transplantation for
Hodgkin's disease
Conventional cytoreduction
None 12
CT 39
CT + RT 38
RT 11
Conditioning
CBV 29
CBVP 71
Stem cell source
Marrow 91
Blood ± marrow 9
Posttransplant growth factors 24
CT, chemotherapy with MVPP; RT, involved field radiotherapy.
initial therapy, and the majority of patients were in first relapse after combination
chemotherapy at the time of entry into transplant protocols.
After protocol entry, 77 patients received brief conventional cytoreduction
therapy with two cycles of MVPP (mechlorethamine, vinblastine, prednisone,
procarbazine), with or without involved-field radiotherapy. Nine received
involved-field radiotherapy alone before conditioning, whereas two were given
radiotherapy after, rather than before, transplant. The median number of regimens
before conditioning was 2 (range 2-7). Patients were not formally restaged after
conventional cytoreduction; all patients receiving MVPP and/or radiotherapy
proceeded to autoSCT.
These patients were conditioned with high-dose cyclophosphamide (7.2 g/m 2
),
BCNU (500-600 mg/m 2
), and etoposide (2.4 g/m 2
) with or without conventionaldose
cisplatin (150 mg/m 2
) (CBV or CBVP). 12
Steady-state bone marrow was the
source of stem cells in the majority of patients, while post-autoSCT growth factors
were available only for patients treated after 1990. Treatment features are
summarized in Table 2.
All patients were hospitalized in single rooms with high-efficiency particulate
air filtration. Blood products were irradiated and given to keep hemoglobin >90 g/L
and platelet count >20X10 9
/L. Antibiotics, antiviral drugs, and antifungal agents
were given as needed.
RESULTS
At a median follow-up period of 8.0 years, PFS is 50% (95% CI 39-60%) (Fig.
1). The probability of relapse is 38% (95% CI 28-51%) (Fig. 2), and the risk of