No abstract

Summary:The use of conventional-dose salvage chemotherapy in The purpose of this study was to investigate the results patients with Hodgkin's disease who relapse after initial of high-dose therapy and autologous stem cell transcombination chemotherapy is associated with high plantation in adult patients with Hodgkin's disease in remission rates, especially if the initial CR duration is first relapse after chemotherapy, to determine the overlonger than 1 year. 1-5 However, long-term follow-up studall and progression-free survival, identify prognostic ies have shown that less than 20% of these patients achieve factors for outcome, and to define the role of conventional dose salvage therapy given prior to the high dose long-term disease-free survival. 6 regimen. A retrospective analysis of 139 adult patients High-dose therapy, with autologous stem cell transplanreported to the lymphoma registry of the European tation (ASCT), has been used extensively in patients with Group for Blood and Marrow Transplantation (EBMT)relapsed Hodgkin's disease. [7][8][9][10][11][12][13][14] In early studies, its use was between February 1984 and July 1995 is considered.confined to patients who had failed multiple combination Data on all patients were reviewed and prognostic facchemotherapy regimens. Analysis of prognostic factors in tors determined in univariate analysis. The actuarial 5-these studies demonstrated that extensive prior therapy, year overall survival (OS) and progression-free survival short remission duration, resistance of disease to conven-(PFS) for the entire group of 139 patients were 49.4 and tional-dose chemotherapy and bulk disease at the time of 44.7%, respectively. In univariate analysis for OS, dis-ASCT were commonly identified adverse features. ease bulk at the time of high-dose therapy, second-line As a result of these findings, and of decision analyses regimen, initial remission duration and status at transregarding the use of high-dose therapy, 15 several groups plant had no predictive value. Status at transplant was have recently reported the use of high-dose therapy in predictive for OS when patients in second complete patients with Hodgkin's disease at the time of the first remission (CR) were analysed separately from those in relapse after chemotherapy. 10,13,14,16 These single institution chemosensitive relapse. Similar trends were observed studies have shown a favourable outcome for these patients for PFS. We concluded that high-dose therapy and autocompared with historical series of conventionally treated logous stem cell transplantation is an effective strategy patients, and have again identified prognostic factors for for patients with Hodgkin's disease in first relapse after long-term disease-free survival, including duration of initial chemotherapy. These results suggest that it should be remission, disease bulk at the time of ASCT, and sensitivity used regardless of initial remission duration. The role to conventional-dose therapy given prior to the high-dose of conventional-dose salvage give...

Immune cell composition of lymph nodes did not correlate with OS in this analysis of trials in FL. The mechanism of the observed correlation between MUM-1 expression and adverse prognosis in patients receiving monoclonal antibody therapy requires confirmation.

Summary A systematic review of the literature was undertaken to assess what published evidence is currently available to support the increasing use of autologous stem cell transplantation (ASCT), and to evaluate the published data with regard to the comparative cost of highdose and conventional therapy. The review aimed to identify all published, randomized controlled trials (RCTs) comparing high-dose therapy (HDT) with ASCT versus conventional chemotherapy (CC) in acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma, and breast, lung, testicular and ovarian cancer. The review also aimed to identify all studies that had compared the cost of the two treatment strategies. Reports were identi¢ed by systematic searches of Cancerlit, Embase and Medline, and handsearching of several conference proceedings. Where possible, pooled odds ratios (ORs) were calculated according to the ¢xed-e¡ect model. A total of 18 randomized trials were identi¢ed in acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma, and breast, lung and testicular cancer. Trials were generally small and no disease site had su¤cient information to determine reliably whether high-dose therapy with autologous transplant is more e¡ective than CC. Five studies were identi¢ed that compared the cost of the two treatments. These found the cost of HDT to be between one and four times higher than that of CC. Further randomized trials are required. Where appropriate, these should include economic assessment and assessments of long-term toxicity.