VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

PROGNOSTIC FACTORS IN ADVANCED STAGE HODGKIN'S DISEASE.
DEFINITION OF PATIENTS WHO CAN BENEFIT FROM ABMT.
A.M.CARELLA, N.POLLICARDO, E.PUNGOLINO, D.PIERLUIGI, S. NATI,
E. ROSSI, R,VIMERCATI, M.SPRIANO, D.OCCHINI.
Autologous BMT Section, Ospedale S.Martino, 16132 Genoa, (ITALY).
Supported by A.I.R.C. 1992.
Over these last two decades, modern therapy has resulted in approximately
70% of patients cured. If a patient fails to achieve remission or precociously relapses,
the chances of being cured by conventional "salvage" therapy is small.
Such poor risk patients have now been investigated worldwide with high-dose
therapy and ABMT. Review of the worldwide experience enrolled ABMT protocols
in Hodgkin's disease shows that the patients normally selected for such procedures
will fall into the following categories:
1. patients with advanced disease who do not achieve remission upon ABVDcontaining
regimen, who have nodular sclerosis (grade II), mixed cellularity
or lymphoid depletion histology, combined with ESR > 50 at presentation.
2. patients who relapse within a short time (usually < 12 months) after ABVD -
containing regimen - inducing remission.
3. patients who relapse after receiving two or more lines of treatment.
Factors that have been suggested to have a negative prognostic impact in
advanced Hodgkin's disease are many but these analyses have been done retrospectively
and on the basis of the results of single institutions rather than of
comprehensive results obtained by several cooperative groups. Recently in UK,
patients who were nonresponders to first-line therapy, precociously relapsed or
failing two or more lines of treatment, were given high-dose therapy with
ABMT and 67% of them had a remission (CR+PR). The actuarial survival of this
group at 5 years is 55% with a progression free survival of 50%. These results
seem apparently better than the previously reported data from conventional salvage
chemotherapy but, unfortunately, this study was not a prospective randomized
trial 0).
The only prospective randomized trial for this category of patients has been
done from British National Lymphoma Investigation ( 2
). The patients were randomized
to receive high-dose therapy (BEAM) and ABMT or conventional
therapy (rnini-BEAM). The conclusion of this study were: 1) BEAM has a greater
overall survival over rnini-BEAM; 2) Overall event-free survival (event is death
from any cause or progression of disease) is in favor of BEAM (p=0.025); 3) at 3
years, 53% of patients randomized to receive BEAM were alive and well compared
to only 10% of the rnini-BEAM arm. Progression free survival is also in
favor of BEAM and it is highly superior (p=O.005). The results achieved with
BEAM seem to confirm the previous single center studies.
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 83