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Refractory and relapsing Hodgkin's disease: Role of high-dose chemotherapy with bone marrow transplantation

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Summary

Thirty percent of adult patients with Hodgkin's disease fail primary treatment or relapse after treatment. Whereas overall mortality for Hodgkin's disease is about 20%, half the patients who relapse will die.

Among patients with refractory or relapsing disease, about a third can be rescued by conventional salvage treatment. Unfortunately, except for patients with late relapse, remission after conventional salvage treatment is generally not of long duration.

However, durable complete remissions can now be achieved in nearly a third of patients with refractory or relapsing disease by means of very aggressive (myeloablative) chemotherapy with consecutive autologous bone marrow transplantation (aBMT).

The rate of durable complete remissions seems to be even higher if previous exposure to chemotherapeutic agents is not in excess of two different treatment protocols (optimal timing of aBMT) and if responsiveness to cytotoxic drugs is preserved (low degree of drug resistance).

Bone marrow transplantation should be restricted to patients whose resulting long-term prognosis justifies such radical treatment. Reflecting ongoing clinical therapy-studies, in particular in Germany, the role of bone marrow transplantation in a general concept of salvage treatment should be pointed out. Patients should be considered candidates if they fail alternating primary chemotherapy or develop an early relapse after this treatment, but still show responsiveness to chemotherapeutic agents.

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Abbreviations

aBMT:

autologous bone marrow transplantation

pS:

pathological staging

C[M]OPP/ABVD:

Cyclophosphamide [Mustargen], Vincristine (Oncovin), Procarbazine, Prednisone/Doxorubicin (Adriamycin), Bleomycin, Vinblastine, Dacarbazine

CEVD:

Lomustine (CCNU), Etoposide, Vindesine, Dexamethasone

Dexa-BEAM:

Dexamethasone, Carmustine (BCNU), Etoposide, Cytarabin (Ara-C), Melphalan

COPP/ABV/IMEP:

Cyclophosphamide, Vincristine (Oncovin), Procarbazine, Prednisone/Doxorubicin, Bleomycin, Vindesine/Ifosfamide, Methotrexate, Etoposide, Prednisone

CEP:

Lomustine (CCNU), Etoposide, Prednimustine

MIME:

Mitoguazone, Ifosfamide, Methotrexate, Etoposide

CVB:

Cyclophosphamide, Etoposide (Vepeside), Carmustine (BCNU)

CR:

complete remission

n.r.:

not reported

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Thomas, M., Gattermann, N. & Schneider, W. Refractory and relapsing Hodgkin's disease: Role of high-dose chemotherapy with bone marrow transplantation. Klin Wochenschr 68, 539–544 (1990). https://doi.org/10.1007/BF01667145

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