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Total Body Irradiation Followed by Autologous Stem Cell Transplantation Best Option for Chemoresistant Hodgkin's Lymphoma: Presented at ASH

By Bruce Sylvester

ATLANTA, GA -- December 13, 2005 -- Total body irradiation (TBI) followed by autologous stem cell transplantation appears to be the best option for patients with refractory chemoresistant Hodgkin's lymphoma, researchers report.

They presented the findings here on December 11^th at the 47^th Annual Meeting of the American Society of Hematology (ASH).

"Patients with Hodgkin's disease who have chemoresistance and who are going to undergo [stem cell] transplants need to get total body irradiation as part of their preparatory regimen," said lead investigator Tracee Metcalfe, MD, resident physician in internal medicine, Washington University, St. Louis, Missouri.

Although preparatory TBI has become the basic standard of care for patients with relapsed Hodgkin's lymphoma, Dr. Metcalfe pointed out that there have been few studies that examined the impact of treatment on overall survival and progression-free survival in this patient population.

Dr. Metcalf and colleagues examined data on 172 Hodgkin's lymphoma patients who had undergone standard high-dose therapy followed by autologous stem cell transplantation. They identified 66 patients with chemoresistant disease, defined as < 50% reduction in the size of the tumor with the chemotherapy regimen immediately preceding high dose therapy.

Of the patients with chemoresistant disease, 41% received TBI-based preparatory regimens and 59% underwent non-TBI conditioning, Dr. Metcalfe reported.

The 66 patients were followed for a median of 2.6 years.

The researchers found that the estimated 5-year overall survival was 31% and progression-free survival was 18%.

Of the 39 deaths, 56% were the result of relapses and 44% were due to nonrelapse causes such as infections, cardio-pulmonary disease, or unknown causes.

Multivariable modeling implemented identified nodular sclerosis and non-TBI conditioning to be associated with poorer outcomes in terms of overall survival and progression free survival.

Based on their findings, the researchers concluded that high-dose chemotherapy and autologous stem cell transplant may result in prolonged remissions and survival for a significant minority of chemoresistant Hodgkin's lymphoma patients, with improved outcomes observed in those treated with TBI-based regimens.

"The take-home message from our research is that they will do better if they also receive total body irradiation treatment," Dr. Metcalfe added.


[Presentation title: Efficacy of High-Dose Therapy and Autologous Stem Cell Transplantation for Chemoresistant Hodgkin's Lymphoma. Session Type: Poster Session 285-II. Abstract 2081]

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