INTENSIVE THERAPY AND AUTOLOGOUS STEM-CELL TRANSPLANTATION FOR HODGKINS-DISEASE IN FIRST RELAPSE AFTER COMBINATION CHEMOTHERAPY

Data from a number of transplant centers has shown that several intens ive therapy regimens, supported by autologous stem cell transplantatio n, have the capability to produce durable responses in a proportion of patients with Hodgkin's disease progressive after combination chemoth erapy. Although many questions regarding the optimal use of autotransp lantation remain unanswered, the issue of the preferred timing at whic h to apply transplantation is of critical importance in planning thera peutic strategies for patients with this disease. This paper will focu s on the timing options for autotransplantation in Hodgkin's disease. In the absence of a formal Phase III study comparing conventional salv age therapy versus autotransplantation in first relapse patients, the encouraging results from our center and others support the use of tran splantation at the time of first relapse after combination chemotherap y. Non-relapse mortality is tow in this setting, and the primary probl em has been recurrent disease despite transplantation. Risk factors fo r both disease recurrence, as well as for the probability of progressi on-free survival, can be defined based on biologic features present at the time of first relapse after chemotherapy, and may provide a basis for improving the current transplant results for first relapse patien ts. Prolonged follow-up will be important to define the incidence and risk of late toxicities in autografted patients.