Kessinger A, Nademanee A, Forman S J, Armitage J O
University of Nebraska Medical Center, Omaha.
Hematol Oncol Clin North Am. 1990 Jun;4(3):577-87.
Modern high-dose therapy with autologous bone marrow transplantation (ABMT) used for the management of Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NHL) began about a decade ago. As more lymphoma patients are treated and followed for longer periods of time, the value of this procedure is becoming clearer. ABMT for low grade NHL has not been studied extensively and follow-up is too short to demonstrate definite efficacy, but initial reports have suggested advanced low-grade NHL might be eradicated for some patients. More than a third of patients with intermediate- and high-grade lymphomas that are refractory to standard therapy or demonstrate poor prognostic factors, when treated with high-dose therapy and ABMT, experience long-term, disease-free survival. About 30% of patients with Hodgkin's disease that was not eradicated with conventional therapy experience long-term, disease-free survival when treated with high-dose therapy and ABMT. Patients who cannot have ABMT because of some bone marrow abnormality, can be offered high-dose therapy and restoration of marrow function by transplantation of hematopoietic stem cells collected from the peripheral blood rather than the marrow with no increased risk of failure to achieve long-term, disease-free survival. Continued efforts to reduce the morbidity and mortality associated with high-dose therapy, to identify the optimal high-dose therapy for each histologic type of lymphoma, and to better identify those patients most likely to benefit will improve the value of high-dose therapy and ABMT.
