Accelerated hyperfractionated total-lymphoid irradiation, high-dose chemotherapy, and autologous bone marrow transplantation for refractory and relapsing patients with Hodgkin's disease Journal Article


Authors: Yahalom, J.; Gulati, S. C.; Toia, M.; Maslak, P.; McCarron, E. G.; O'Brien, J. P.; Portlock, C. S.; Straus, D. J.; Phillips, J.; Fuks, Z.
Article Title: Accelerated hyperfractionated total-lymphoid irradiation, high-dose chemotherapy, and autologous bone marrow transplantation for refractory and relapsing patients with Hodgkin's disease
Abstract: Purpose: To evaluate the feasibility and therapeutic effect of accelerated hyperfractionated total-lymphoid irradiation (TLI), high-dose chemotherapy, and autologous bone marrow transplantation (AuBMT) in patients with relapsing or chemotherapy-resistant Hodgkin's disease (HD). Patients and Methods: Forty-seven patients with HD who either relapsed after chemotherapy (n = 19), or failed to respond (n = 28) to at least two regimens of combination chemotherapy were studied. No patient received prior radiation therapy (RT). Treatment started with reinduction with standard-dose chemotherapy, followed by involved-field irradiation (15 Gy) to areas of relapsed or persistent disease and TLI (20.04 Gy given in 1.67 Gy fractions three times per day for 4 days). Subsequently, patients received etoposide and high-dose cyclophosphamide, followed by infusion of unpurged autologous bone marrow. All surviving patients had a minimum follow-up duration of 1 year. The median follow-up duration for survivors was 40+ months, and the maximum follow-up duration was 80+ months. Results: Of the 47 patients treated, eight (17%) died of toxicity during the peritransplant period. Twenty-nine of the remaining 39 assessable patients (74%) attained a complete response (CR), while 10 remained with residual disease and progressed early after AuBMT. Four of the CR patients (14%) relapsed and 25 patients remained alive and free of disease. The actuarial disease-free survival (DFS) rate for the entire group at 6.5 years was 50%. Patients who received the protocol for relapsing HD had a significantly better DFS rate (79%) compared with patients treated for continuous refractory disease (DFS, 33%; P < .03). Conclusion: Previously unirradiated patients with relapsing or chemotherapy-resistant HD who have exhausted conventional chemotherapy may still respond to an aggressive therapeutic approach consisting of accelerated hyperfractionated TLI, high-dose chemotherapy, and AuBMT rescue. This program offers a potential for long-term DFS to approximately one half of patients who would otherwise have a dismal prognosis with standard-dose salvage therapy.
Keywords: adolescent; adult; cancer survival; child; clinical article; school child; prednisone; cancer recurrence; cisplatin; doxorubicin; cancer combination chemotherapy; cancer radiotherapy; cytarabine; drug megadose; dacarbazine; etoposide; cyclophosphamide; dexamethasone; vincristine; chlormethine; lomustine; procarbazine; thiotepa; vinblastine; hodgkin disease; cancer resistance; survival time; radiation dose fractionation; bleomycin; bone marrow rescue; lymph node irradiation; intravenous drug administration; autologous bone marrow transplantation; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 11
Issue: 6
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1993-06-01
Start Page: 1062
End Page: 1070
Language: English
DOI: 10.1200/jco.1993.11.6.1062
PUBMED: 8501492
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus
Altmetric Score
MSK Authors
  1. Joachim Yahalom
    417 Yahalom
  2. Zvi Fuks
    320 Fuks
  3. Carol Portlock
    184 Portlock
  4. James O'Brien
    17 O'Brien
  5. Peter Maslak
    170 Maslak
  6. David J Straus
    222 Straus
  7. Subhash C. Gulati
    36 Gulati