Intensive therapy and autotransplantation in hodgkin's disease

Abstract

Intensive therapy and autologous marrow or peripheral blood stem cell transplantation is often utilized in Hodgkin's disease patients whose disease has progressed after primary conventional chemotherapy. A number of studies have described long-term disease-free survival in up to 50% of transplanted patients. High-dose chemotherapy conditioning regimens such as "CBV" or "BEAM" have been used more often than regimens containing total body irradiation. Usually unpurged autologous bone marrow has been utilized as the source of hematopoietic stem cell reconstitution, although recently the use of "primed" peripheral blood stem cells has increased markedly. The challenges of transplant-related toxicity and recurrence of disease post-transplant are discussed, as well as possible strategies to reduce these problems. The use of autologous transplantation is discussed in three clinical settings: patients who have failed to enter a complete remission (CR) after primary chemotherapy, those who have relapsed within 12 months of attaining a CR and those who have relapsed after a longer (i.e., > or = 12 months) first CR. When compared with conventional salvage chemotherapy, transplantation appears to produce a higher long-term disease-free survival rate in all of these patient groups. However, assessment of an advantage for autotransplantation, particularly in patients with long first remissions, is difficult without a Phase III trial. On the other hand, recently updated results from our center indicate that 72% of patients relapsing after long initial remissions benefit from autotransplantation at this point in their disease course, and that transplant-related mortality is low in this setting. Other issues addressed include the potential role of autologous transplantation as consolidation therapy in selected high-risk patients in an initial CR, as well as the utility of conventional chemotherapy and involved-field radiotherapy in conjunction with autotransplantation.

Heart Rate Variability and Heart Rate Turbulence in Patients with Hematologic Malignancies Subjected to High‐Dose Chemotherapy in the Course of Hematopoietic Stem Cell Transplantation

“…1,2 Also other strategies of antineoplastic therapy may cause cardiotoxicity of a clinical significance, as exemplified by cyclophosphamide treatment in patients with malignant lymphoma. 3,4 Nevertheless, clinical observations suggest that cardiovascular complications may appear in some patients in a course of peripheral blood (PB) stem cell transplantation and also there is a serious risk of developing some long-term complications. In hematological malignancies, sustained remissions and even cures may be achieved in certain patients by use of HSCT following the high-dose chemotherapy (HDC).…”

“…In hematological malignancies, sustained remissions and even cures may be achieved in certain patients by use of HSCT following the high-dose chemotherapy (HDC). 3,4 Nevertheless, clinical observations suggest that cardiovascular complications may appear in some patients in a course of peripheral blood (PB) stem cell transplantation and also there is a serious risk of developing some long-term complications. Until now, a detailed range of possible cardiovascular complications and potential cardiotoxic effects of stem cells administration in individual groups of patients remains unknown.…”

Autologous Stem Cell Transplantation in the Treatment of Cancer

“…Data presented in a number of studies (41)(42)(43)(44)(45) have demonstrated a long-term disease-free survival of Recently, autologous blood stem cells have been utilized in cases where potential harvest sites (hips) have been irradiated. Results from two larger series suggest that some patients may become cured (46,47).…”

Using ‘amenable mortality’ as indicator of healthcare effectiveness in international comparisons: results of a validation study

“…The main innovation between 1970 and 2005 was high-dose chemotherapy combined with peripheral blood stem cell transplantation for those whose disease was not responding to conventional chemotherapy 42. This was introduced in the late 1980s and 1990s, with considerable variation between countries (table 1).…”