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High dose chemotherapy and autologous bone marrow transplantation in advanced Hodgkin's disease
Author(s) -
Morgan Marianne J,
Dodds Anthony J,
Downs Kathryn,
Wolf Max,
Januszewicz Henry,
Ma David,
Downs Kathryn,
Cooper Ian
Publication year - 1992
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1992.tb137348.x
Subject(s) - medicine , procarbazine , abvd , surgery , vincristine , nodular sclerosis , dacarbazine , transplantation , cyclophosphamide , chemotherapy , vinblastine , etoposide , prednisone , lymphoma , hodgkin lymphoma
Objective To present the use of high dose chemotherapy with autologous bone marrow transplantation as salvage therapy for advanced Hodgkin's disease in Australia. Design A prospective open study for patients whose disease was resistant to conventional treatment. Setting The bone marrow transplantation units of four Australian tertiary hospitals. Patients Seventeen patients (median age 30 years) entered and completed the study. The stage of the disease at initial diagnosis was I or II (seven patients), III (seven patients) and IV (three patients). Histological types were lymphocyte predominant (one), nodular sclerosis (12), mixed cellularity (three) and unknown (one). Therapy before consideration for transplantation included radiotherapy (13), mustine, vincristine, procarbazine and prednisone (MOPP — 17 patients) or doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD —13 patients) and other chemotherapy regimens (five). The median interval from diagnosis to transplantation was 29 months (range, 9–178 months). The patient's disease was classified as sensitive (nine) or resistant (eight) to treatment, depending on the response to the most recent course of Chemotherapy. Interventions Morphologically normal autologous bone marrow was harvested and cryopreserved. The Conditioning regimen given was cyclophosphamide, carmustine and etoposide (14) or busulphan and cyclophosphamide (three). The marrow was then infused. Main outcome measures Remission (complete or partial), disease‐free survival and overall survival. Results Over all, 10 of 17 patients (59%) entered or remained in complete remission and four of 17 (24%) achieved partial remission. The overall actuarial survival at 30 months was 70%. Eight of the nine patients with treatment‐sensitive disease (89%) remain disease‐free at a median of 22 months (range, 18–29 months) after transplantation. Two of the eight patients with resistant disease (25%) are disease‐free at 20 and 28 months. There was one procedure‐related death from haemorrhage arid four diseaserelated deaths at six, seven, eight and 13 months after transplantation. Conclusion Autologous bone marrow transplantation may provide an effective salvage therapy in advanced Hodgkin's disease, particularly for patients with treatment‐sensitive disease and a low tumour burden.