Increasing the dose or intensity of chemotherapy requiring bone marrow transplant support is demonstrated to cure more patients with resistant or recurrent Hodgkin’s lymphoma than standard-dose chemotherapy.
It has previously been demonstrated by several cancer centers around the world that very high doses of chemotherapy that damaged the bone marrow and therefore required replacement of the bone marrow or a bone marrow transplant cure more patients with Hodgkin’s disease than chemotherapy agents that do not require bone marrow support.
Patients with Hodgkin’s disease that did not achieve a clinical remission to initial therapy or relapsed after achieving an initial complete remission were treated in a clinical study that directly compared a maximum amount of chemotherapy that could be given without bone marrow support with the same chemotherapy given at much greater doses that required bone marrow transplantation support. In this direct comparison of high-dose chemotherapy treatment with bone marrow transplantation compared to the same chemotherapy drugs without bone marrow transplantation, 5 times as many patients who received high-dose chemotherapy and bone marrow transplant were cured at 3 years compared to patients treated with the lower non-bone marrow transplant supported chemotherapy doses. At 3 years from initiation of treatment, 53% of patients receiving high-dose chemotherapy were alive without evidence of disease compared to 10% receiving lower dose chemotherapy. Although patients receiving high-dose chemotherapy were 5 times as likely to be cured and alive without evidence of disease recurrence, the toxicity of the high-dose chemotherapy was significantly greater than the lower dose chemotherapy. Ten percent of patients died from complications of the high-dose chemotherapy and autologous bone marrow transplant treatment strategy. This clinical study demonstrated that high-dose chemotherapy and autologous bone marrow transplantation is a standard treatment option for patients with resistant or relapsed Hodgkin’s disease because it significantly improved cure and survival rates despite the toxicity associated with the treatment. (Lancet; 341: pp 1051-1054, 1993)