High-dose chemotherapy with autologous stem-cell support has clearly demonstrated efficacy in patients with relapsed or refractory Hodgkins disease (Horning et al: Blood 89:801-813, 1997) and is probably superior to salvage chemotherapy in this setting (Yuen et al: Blood 89:814-822, 1997). Disease burden and chemosensitivity have been shown to be predictive of long-term outcome following the transplant. However, a clear advantage may be difficult to demonstrate because of late complications, including secondary malignancies, particularly acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) (Roberts et al, abstract #2984).
The retrospective analysis presented by the City of Hope investigators (Nademanee et al, abstract #2983) suggested that the outcome of transplantation is best when performed during first remission. However, such an analysis is subject to selection bias and requires confirmation by prospective trials.
Bruce D. Cheson, MD