SHOULD HIGH-RISK PATIENTS WITH HODGKINS-DISEASE BE SINGLED OUT FOR HEAVIER THERAPEUTIC REGIMENS WHILE LOW-RISK PATIENTS ARE SPARED SUCH THERAPIES

In order to optimize the use of intensive therapy and autologous trans plantation in patients with progressive Hodgkin's disease, we have exa mined the outcome of our initial 100 patients entered into autograft s tudies between 1985 and 1992. At a median follow-up of 3.6 (range 1.6- 8.2) years, the actuarial progression free survival (PFS) was 46% (95% confidence intervals 33%-57%). The most significant determinant of PF S was the disease status at the time of protocol entry. Patients enter ed into transplant studies at the time of first untested relapse had a PFS of 61% compared with 38% in those who had failed induction chemot herapy, 25% in patients treated in greater than or equal to second unt ested relapse and 0% in those in a chemoresistant relapse. The reasons for failure differed, however, in that a high non-relapse mortality w as seen in the greater than or equal to second untested relapse and re sistant relapse groups while a high probability of relapse was observe d in the induction failures and resistant relapse group. The most obvi ous group to target with more intensive therapeutic regimens consists of patients who have failed induction chemotherapy.