HIGH-DOSE THERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN FIRSTCOMPLETE OR PARTIAL REMISSION FOR POOR-PROGNOSIS HODGKINS-DISEASE

We report the experience of three French centres which evaluated high- dose therapy (HDT) as consolidation therapy for poor prognosis Hodgkin 's disease (HD). From March 1986 to April 1990, 23 consecutive patient s with poor prognosis stage IV HD underwent HDT followed by autologous bone marrow transplantation (AB MT) after achieving either complete r emission (CR 1) or good partial response (GPR1) (reduction mass > 75%) . The median age was 31 years (range 18 to 55 years), 14 were male. Ai l patients except one initially had at least 2 poor prognosis factors such as: systemic symptoms (n = 19), bulky tumor (n = 16), more than o ne extranodal site (n = 9), bone marrow involvement (n = 5), lymphocyt e count less than or equal to 1.10(9)/1 (n = 8) and biological stage b (n = 21). All patients had previously been treated with alternating M OPP/ABVD. Ten patients were in GPR1 and 13 in CR1 before transplant. T he conditioning regimens were: CBV (n = 17), BEAM (n = 5), BEAC (n = 1 ) followed by bone marrow rescue. Radiotherapy was introduced just bef ore the conditioning regimen for 6 patients or after ABMT for 5 patien ts. Nine of 10 patients in GPR1 achieved CR after ABMT but one died ea rly of treatment-related toxicity. Five of 22 patients who were in CR posttransplant, relapsed (3, 4, 4, 18, 36 months). Seventeen patients remain alive in continuous CR with a median follow-up of 60 months (ra nge: 30-100 months). The overall survival (OS) and disease-free surviv al (DFS) projected at 5 years are 92% and 77% respectively. Consolidat ion by HDT and ABMT proved to be well tolerated. An international tria l is currently underway to attempt to demonstrate a clear benefit on s urvival for this subset of poor prognosis HD patients.