Autologous bone marrow transplantation for refractory or relapsed Hodgkin’s disease: The Memorial Sloan-Kettering Cancer Center experience using high-dose chemotherapy with or without hyperfractionated accelerated total lymphoid irradiation

Summary

Fifty patients with advanced-stage Hodgkin’s disease (HD) who relapsed or failed to respond to multiple regimens of combination chemotherapy were entered onto two autologous bone marrow transplantation (AuBMT) protocols. Twenty-eight patients who did not have prior radiation therapy were treated with protocol A. Protocol A consisted of reinduction with conventional doses of combination chemotherapy followed by boost local-field irradiation to areas of residual disease and hyperfractionated accelerated total lymphoid irradiation (TLI). Chemotherapy consisted of high-dose etoposide (VP-16) and cyclophosphamide followed by infusion of cryopreserved, unpurged autologous bone marrow. Twenty-two patients who have had prior radiation therapy were treated with protocol B. Protocol B consisted of reinduction with conventional doses of chemotherapy followed by involved field radiation therapy (when tolerance to residual disease has not been previously reached). High-dose chemotherapy regimen consisted of cyclophosphamide, carmustine (BCNU), and VP-16 (CBV) followed by autologous bone marrow transplantation.

Of the 28 patients in protocol A, 5 patients died during the immediate peritransplant period, 5 patients progressed within six months, and 2 of them died. Two patients relapsed 13 and 39 months post transplant; 1 of them was reinduced into a complete remission (CR). Seventeen patients (61%) are disease free (16 patients in continuous complete remission), 12−54+ months (median 25+ months) following completion of therapy. Of the 22 patients in protocol B, 1 died of cytomegalovirus pneumonitis, and 11 relapsed. Ten patients (45%) are alive and disease free 16−42+ months (median 23+ months) after therapy.

In both protocols, patients who had responded to the reinduction chemotherapy, which was given prior to the transplant regimen, had a significantly better chance of remaining disease free (69 versus 13%, P < 0.00001). Treatment with protocol A resulted in a high rate of complete remission and a relative by low relapse rate, but was associated with considerable toxicity. Protocol B was less toxic but carried a higher risk of relapse. Both protocols offer a potential cure for patients with refractory or relapsed Hodgkin’s disease who have exhausted conventional modes of therapy.