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

lished data to attempt to assess this point further, the results of 58 consecutive
patients transplanted in Vancouver at the time of untreated first relapse will be
reported.
PATIENT SELECTION
Of the 58 autotransplanted in Vancouver, only those 42 patients from British
Columbia (B.C.) are traceable from diagnosis. These patients were part of a
larger group of 53 B.C. patients with Hodgkin's disease who failed primary chemotherapy
(mostly with MOPP/ABV[D]) and were 15-65 years of age; this
number represents virtually all such patients residing in B.C. who were seen
during that time. The other 11 B.C. patients were not transplanted: 3 refused any
subsequent therapy, 7 were preferentially given local irradiation due to an anticipated
good prognosis and 1 patient who was previously misdiagnosed received
induction chemotherapy alone. No patient was excluded for disease- or
treatment-related reasons. Even if these 11 patients were included in the analyses
described herein, the results would differ only slightly from those detailed
below. In brief, we did not exclude patients from AuBMT due to anticipated adverse
prognostic factors and thus do not believe that patient selection (as defined)
spuriously "improves" our results.
PATIENT CHARACTERISTICS (TABLE 1)
All 58 patients had definite progression; patients with mere persistence of
radiographic abnormalities were not treated. Patient median age was 31 years;
49 patients had nodular sclerosing histology. Previous treatment included
MOPP/ABV(D) in 51 patients; radiotherapy had been given in 20. Thirty-five of
these patients had a median time between initial remission and progression of <
12 months and 16 had "B" symptoms at the time of AuBMT. Six had a history
(i.e., at any time since diagnosis) of bone marrow positivity; at the time of marrow
harvest, however, all save one had normal (or near-normal) marrow cellularity
and histology. This patient underwent unstimulated peripheral blood harvest
and subsequent reinfusion.
TREATMENT SCHEMA (FIGURE 1)
Patients who had a progression-free interval of > 3 months were harvested,
and then received MVPP x 1-4 courses, either with (n=25) or without (n=24) local
radiotherapy; 3 received radiotherapy alone. Those few who had shorter intervals
were harvested and transplanted without receiving MVPP; some received
radiotherapy. It is important to emphasize that the MVPP cycles were not
used as a selection method and such patients were not meticulously restaged
after MVPP; all patients who were harvested were eventually transplanted.
TREATMENT DETAILS
Intensive conditioning was given with "CBV" as previously reported8 and,
more recently, with "CBViP"9 (Figure 2). Our own toxicity data, as well as the
Phase I study of Wheeler et al,10 have led us to conclude that these represent
near-maximal doses of the agents utilized - especially BCNU.
Fifty-seven patients received unpurged autologous marrow and 1 received
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 87