High-Dose Cyclophosphamide, Carmustine, and Etoposide and Autologous Bone Marrow Transplantation for Relapsed Hodgkin's Disease

Abstract

Thirty patients with relapsed Hodgkin's disease were treated with high-dose cyclophosphamide, carmustine, and etoposide (CBV) and autologous bone marrow transplantation. The median age of the patients was 28 years, and 18 were male. More than half had extranodal sites of relapse and constitutional symptoms. Most had been heavily pretreated with multiple salvage chemotherapy regimens and radiotherapy. At the time of transplantation, 23 patients were having progressive disease despite salvage chemotherapy. High-dose CBV chemotherapy induced complete responses in 15 patients and partial responses in 10 patients. Eleven patients are still in complete remission, 1 of whom has had an unmaintained remission for more than 44 months. Toxicity was moderate; all patients had severe myelosuppression requiring supportive therapy, and 1 patient failed to reconstitute her bone marrow. High-dose CBV chemotherapy and autologous bone marrow rescue proved to be effective as salvage therapy for a select group of heavily pretreated patients with relapsed Hodgkin's disease.

Rituximab purging and maintenance combined with auto-SCT: long-term molecular remissions and prolonged hypogammaglobulinemia in relapsed follicular lymphoma

“…Seven patients received the rituximab infusion on the third day of G-CSF and the remaining patients were treated 3 days before initiation of G-CSF. Those patients who achieved greater than or equal to 75% reduction in measurable disease after salvage chemotherapy proceeded to HDT conditioning with CBV (cyclophosphamide, BCNU, etoposide) 39 followed by autologous stem cell infusion. Two 4-week courses of rituximab at 375 mg/m 2 were administered intravenously as maintenance therapy 8 and 24 weeks after auto-SCT.…”

Serum lactate dehydrogenase level as a prognostic factor in Hodgkin's disease

“…This progressive improvement has been based on adequate prospective therapeutic trials combined with careful clinicopathologic and prognostic factor analysis (Bennett et al, 1983;Desch et al, 1992;Hoppe et al, 1982;Loefler et al, 1988;Specht et al, 1988;Strauss et al, 1990;Tubiana et al, 1989;Wedelin et al, 1984). However, there is still a group of patients refractory to initial treatment that will be candidates for alternative therapeutic approaches (Gribben et al, 1989;Jagannath et al, 1986;Yahalom et al, 1989). The definition of new prognostic factors that allows the identification of such patients at the actual time of diagnosis will be of great value.…”

Autologous transplantation in poor risk Hodgkin's disease using high dose melphalan/etoposide conditioning with non-cryopreserved marrow rescue

“…The choice of preconditioning for HD was based on our experience with melphalan in high grade non-Hodgkin's lymphoma autotransplants and the fact that it had been shown to have value in other series of ABMT in HD (Russell et al, 1989;Zulian et al, 1989). It was considered that VP16, known to be an active agent in HD, used at high dose would be of benefit Wolff et al, 1983;Blume et al, 1987;Jagannath et al, 1986;Stewart et al, 1991). All agents for this procedure needed a short half-life if our policy of using non-cryopreserved marrow, which is associated with rapid engraftment and lack of procedural mortality (Carey et al, 1991) (range 19-46).…”