ISSN:
1569-8041
Schlagwort(e):
autologous peripheral blood progenitor-cell transplantation
;
CD34+ cells
;
high-dose chemotherapy
;
Hodgkin's disease
Quelle:
Springer Online Journal Archives 1860-2000
Thema:
Medizin
Notizen:
Abstract Background:The use of autologous peripheral blood progenitorcells (PBPC) expedites hematologic recovery and reduces the costs oftransplantation in comparison with autologous bone marrow; however, itsefficacy in patients with Hodgkin's disease has been questioned. We evaluatedthe results of autologous PBPC transplantation in a population of unselectedand uniformly treated patients with primary refractory or relapsed Hodgkin'sdisease. Patients and methods:Forty consecutive adult patients withprimary refractory (n = 7) or relapsed (n = 33) Hodgkin'sdisease received high-dose BEAM (BCNU, etoposide, ara-C, and melphalan)followed by autologous PBPC infusion. Twenty-four patients (60%)received high-dose BEAM as outpatients. Consolidative radiation therapy wasadministered to 14 patients (35%). Results:Thirty-seven patients (92%) achieved a posttransplant complete response. The 3-year progression-free survival (PFS) was69%, and the 3-year overall survival (OS) was 77%, with a medianfollow-up of surviving patients of 28 months. Severe non-hematologictoxicities included gastrointestinal side effects (diarrhea 17%,mucositis 25%), and interstitial pneumonitis (15%). One patientdied of acute transplant-related complications (mortality rate 2.5%).Strong predictors of poor PFS were chemoresistant versuschemosensitive/untested disease (actuarial PFS 89% versus22%, P = 0.0000) and stage IIB–IV versusI–IIA at relapse/progression (86% versus46%, P = 0.005). All five patients with elevated lactatedehydrogenase at the time of transplantation died of their disease. There wasa trend toward worse PFS for patients receiving a higher number of CD34+ cells(≥11 × 106 per kg). Conclusions:High-dose BEAM chemotherapy with autologous PBPCtransplantation is associated with low mortality and results in satisfactoryPFS for patients with primary refractory or relapsed Hodgkin's disease. Thesubset of patients with progressive disease at the time of transplantationperforms poorly and may benefit from alternative strategies.
Materialart:
Digitale Medien
URL:
http://dx.doi.org/10.1023/A:1008396525292
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