First remission autologous bone marrow transplantation for Hodgkin's disease - preliminary EBMT data

With optimum treatment, approximately 75% of patients with Hodgkin's disease (HD) can expect to be cured. Even for patients with advanced disease, the advent of combination chemotherapy has meant that around 75% are alive at 5 years. Autologous bone marrow transplantation (AMBT) is now accepted as appropriate treatment for those patients who fail to attain a complete remission (CR) on a standard combination regimen, those whose first CR lasts less than a year, those who fail to achieve a second CR or who have a further relapse, and those with refractory disease. The use of ABMT in first CR remains experimental and controversial. The first published data on the application of ABMT for HD in first CR is that of the Genoa group. They identified a poor-risk group of patients according to an analysis of prognostic factors for HD patients treated with MOPP/ABVD at several Italian centres. Fifteen out of 39 patients attaining CR after MOPP/ABVD opted for AMBT and 85% of these remained alive in CR at a median follow up of 36 months post ABMT, compared to 33% of those who opted out of ABMT. We have looked at the 23 patients on the European Bone Marrow Transplant Group registry who underwent ABMT in first CR between November 1979 and July 1992--excluding those patients already reported by the Genoa group. Median age at diagnosis was 28 years (range 16-41%). 70% of patients were male. Most had advanced disease at diagnosis: 39% were stage III, 57% stage IV and 78% had B symptoms. Only 26% of patients remitted after 1 line of therapy. Of the remainder, 57% required 2, and 17% 3 lines of therapy in order to achieve CR. Most (65%) received some form of alternating regimen. Median time from diagnosis to CR was 8.5 months (range 4-19), and from CR to ABMT 2.5 months (range 0-11). ABMT was planned in only 43% of cases at diagnosis. In the remainder, requiring more than 1 line of therapy to achieve CR was given as the main reason for ABMT.