AUTOLOGOUS STEM-CELL TRANSPLANTATION FOR POOR-PROGNOSIS HODGKINS-DISEASE IN FIRST COMPLETE REMISSION - A RETROSPECTIVE STUDY FROM THE SPANISH GEL-TAMO COOPERATIVE GROUP

Although more than 50% of Hodgkin's disease patients are cured with co nventional chemotherapy, many will relapse and eventually die from the ir disease. Many efforts have been made to identify poor prognostic fa ctors that could be useful in selecting high-risk patients in Ist CR w ho may benefit from high-dose chemo/radiotherapy. However, the role of early transplantation in Ist CR remains unclear. We have retrospectiv ely analyzed the results obtained with this procedure in 22 hospitals belonging to the Spanish GEL/TAMO cooperative group. Twenty-seven pati ents, of whom 19 were males, underwent autologous transplantation for Hodgkin's disease in Ist CR between January 1987 and January 1996, Rem ission had been achieved after one (It = 22) or two (n = 5) lines of t reatment. Twenty-four patients had advanced stage disease, 12 patients bulky mediastinal disease, nine bone marrow involvement and 18 had ex tranodal disease, Peripheral blood was used as the source of hematopoi etic stem cells in 15 patients, BM in nine, and both in three. All but three patients received chemotherapy-based conditioning regimens (16 CBV, four BEAM and four BEAC), while three were conditioned with CY an d TBI, There were no transplant-related deaths. Median (range) times t o recover >0.5 x 10(9)/l neutrophils and >50 x 10(9)/l platelets were 14 (8-56) days and 16 (8-240) days, respectively, With a median follow -up of 30 (8-66) months, 21 patients are alive and in continuous CR, F our patients who relapsed after transplant at 8, 17.5, 22 and 26 month s achieved a second CR with conventional chemotherapy; one patient rel apsed 92 months post-transplant and died 5 months afterwards. Another patient died 30.5 months post-transplant from a secondary malignancy. In conclusion, high-dose therapy in poor prognosis Hodgkin's disease i n Ist CR was well tolerated with no transplant-related mortalities, Al though the follow-up of this series is relatively short, our results s eem promising, Nevertheless, late relapses can occur, and the role of this procedure vs conventional treatment in very high-risk patients sh ould be assessed in prospective randomized studies.