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

treated at Memorial Hospital in New York between 1975 and 1984, the major
factors negatively affecting the duration of complete remission were high serum
LDH, age >45 years, mediastinal mass greater than 0.45 of the thoracic diameter,
two or more extranodal sites, inguinal node involvement and low hematocrit.
Patients with two or more unfavorable characteristics were much more likely to
fail treatment than those with none or only one unfavorable factor. The presence
of B symptoms was not associated with a significantly poorer survival;
however, there was only a small percentage of patients with B symptoms in this
study. In other important studies, B symptoms and age more than 40 yeas were
consistently associated with a lower probability of remaining in CR. Similar results
have been reported by Proctor, who has used a numerical prognostic index
for clinical use in the identification of poor-risk patients. Ninety-two consecutive
patients from one center (Newcastle upon Tyne) were used to construct a
numerical index based on disease stage (Ann Arbor), age, hemoglobin and absolute
lymphocyte count. This index provided a useful criteria to identify those
patients with unfavorable prognosis and predestined to die of disease. Recently,
high serum levels of CD30 and the soluble interleukin-2 receptor have been suggested
to indicate a poor prognosis. In addition to these disease-related prognostic
variables, such as dose intensity, may affect the outcome.
On the basis of published data we judge that the definition of high risk for
patients with advanced stage, bulky disease, and constitutional symptoms is appropriate.
However patients with this unfavorable pattern of presentation represent
only a minority of cases, accounting for about 5% of all patients with HD.
Eleven out of 201 patients with HD enrolled in different clinical trials by the Italian
Lymphoma Study Group (Gruppo Italiano per lo Studio dei Linfomi, GISL)
in the last four years fit the above mentioned criteria and can be classified as
high risk patients, and are probably suitable for an aggressive treatment followed
by ASCT.
IS THERE A ROLE OF ABMT IN FIRST REMISSION?
According to the good results in terms of survival and tolerance achieved in
leukemia and non-Hodgkin's lymphomas when appropriate timed aggressive
chemoradiotherapy is followed by ABMT in first CR or PR, the same strategy
has been applied by Carella in very poor prognosis HD patients. In this trial patients
with HD were selected on the basis of the most unfavorable prognostic
features currently considered. The Genoa preliminary study has involved patients
with many of the previously mentioned factors and even worse such as
more than two extranodal sites of disease combined with mediastinal mass
greater than 0.45 of the thoracic diameter at the level of the carina, high level of
LDH and B symptoms. The excellent results of this study should be viewed as
prehminary, even if these results have been recently confirmed from EBMTG
analysis and will be presented at the next EBMT meeting in Garmish (Germany).
Of course, more patients and longer follow-up are needed to define accurately
the curability of very poor prognosis HD with ABMT. The use of ABMT as consolidation
treatment does not seem to be justified for the time being for the majority
of patients with Hodgkin's disease. This experience does not allow to
make firm conclusions regarding the place of HDC in the management of HD.
Despite the fact that this study was small and there were no other reported se-
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 255