28.02.2013 Views

autologous blood and marrow transplantation - Blog Science ...

autologous blood and marrow transplantation - Blog Science ...

autologous blood and marrow transplantation - Blog Science ...

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

738 Chapter 16: Summaries<br />

Patterns of relapse after autotransplant for NHL were described from data<br />

derived from the Lymphoma Registry of the EBMT <strong>and</strong> the University of<br />

Southampton (page 166). While median time to relapse was shorter in patients with<br />

local vs. distant relapse, there was no difference in survival. Moreover, survival<br />

was inversely correlated with histologic grade. Since median survival after relapse<br />

was 15 months, new strategies are required to improve the outlook of this group.<br />

The treatment of patients relapsing after autotransplant has received insufficient<br />

attention <strong>and</strong> lacks a coordinated approach. A step in the right direction is the<br />

"Samosh protocol" from the St. Bartholemew's group (page 139). They provide<br />

evidence that patients with Hodgkin's disease relapsing after autotransplant have<br />

acceptable quality of life <strong>and</strong> superior survival after a multiagent regimen<br />

consisting of lomustine, chlorambucil, s/c bleomycin, vinblastine, <strong>and</strong><br />

methotrexate compared with local radiotherapy <strong>and</strong> single-agent chemotherapy.<br />

More attention is now deservedly directed to investigating late nonrelapse<br />

mortality after autotransplant. In a study of autotransplant recipients with<br />

Hodgkin's disease, Reece <strong>and</strong> colleagues documented an overall nonrelapse<br />

treatment-related mortality rate of 19%. Importantly, 9% of the deaths were late<br />

(>100 days) <strong>and</strong> due to a variety of causes including secondary malignancies,<br />

infection, <strong>and</strong> pulmonary fibrosis. More extensive investigations from other centers<br />

<strong>and</strong> database registries may help to identify risk factors <strong>and</strong> reduce such treatment<br />

failures.

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!