Prognosis of high dose chemotherapy/autologous bone marrow transplantation candidates not receiving this treatment after failure of primary therapy of Hodgkin's disease

Leuk Lymphoma. 1994 Jun;14(1-2):79-89. doi: 10.3109/10428199409049653.

Abstract

In a multicenter study on the therapy of Hodgkin's disease, in 88 out of 297 patients with primary advanced stages IIIB/IV, a failure to the treatment with the alternating chemotherapy COPP/ABVD +/- radiation was recorded. The cause of failure was as follows: tumor progression under current therapy (PD) 23/88, partial response at the end of therapy (PR) 28/88, early nodal relapses 13/88, late nodal relapses 16/88, extranodal relapses 7/88, undetermined localization 1/88.36 months after manifestation of the failure to treatment, 45% of all patients were still alive. In cases of primary PD the prognosis was the worst of all. Only 1/23 of these patients received a long-term continuous complete remission (cCR) with the salvage therapy. 11 patients with only a nodal relapse received a cCR with irradiation alone. These cases could be regarded as low risk relapses. For the high risk relapse group (n = 57) an indication for high dose chemotherapy with subsequent autologous bone marrow transplantation (HDC/ABMT) would have been imperative, following the present-day definition. The probability of survival of these patients who, however, only received a conventional salvage therapy was up to 38% (95% confidence interval 22-54%). Comparing these data with the literature our results seem not to be substantially worse than those for patients who underwent HDC/ABMT. Only in a randomized comparison can the decision be made on whether HDC/ABMT would be superior to high dose conventional chemotherapy supported by hematopoietic growth factors. It is suggested that such a therapy study be performed as soon as possible.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bleomycin / administration & dosage
  • Combined Modality Therapy
  • Cyclophosphamide / administration & dosage
  • Dacarbazine / administration & dosage
  • Dexamethasone / administration & dosage
  • Doxorubicin / administration & dosage
  • Etoposide / administration & dosage
  • Female
  • Hodgkin Disease / drug therapy
  • Hodgkin Disease / mortality
  • Hodgkin Disease / radiotherapy
  • Hodgkin Disease / therapy*
  • Humans
  • Life Tables
  • Lomustine / administration & dosage
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / mortality
  • Prednisone / administration & dosage
  • Procarbazine / administration & dosage
  • Prognosis
  • Prospective Studies
  • Remission Induction
  • Risk Factors
  • Salvage Therapy*
  • Survival Analysis
  • Survival Rate
  • Treatment Failure
  • Vinblastine
  • Vincristine / administration & dosage
  • Vindesine / administration & dosage

Substances

  • Bleomycin
  • Procarbazine
  • Vincristine
  • Vinblastine
  • Etoposide
  • Lomustine
  • Dacarbazine
  • Dexamethasone
  • Doxorubicin
  • Cyclophosphamide
  • Vindesine
  • Prednisone

Supplementary concepts

  • ABVD protocol
  • CEVD protocol
  • COPP protocol