The case for and against high-dose therapy with stem cell rescue for early poor prognosis Hodgkin's disease in first remission

Abstract

After 10 years we are still not clear whether dose escalation with stem cell transplantation is relevant for some patients with poor prognosis Hodgkin's disease in first remission. Some of the problems relating to the controversy relate to the fact that the definition of high risk Hodgkin's disease in terms of prognostic factors is only now in 1998 being delineated properly. It is also possible that some of the dose escalation in lymphoma has taken place without an adequate amount of conventional therapy beforehand. It may be possible that dose escalation should be added to an adequate amount of conventional chemotherapy not integrated in a conventional regimen thus shortening it. Newer studies from the German Hodgkin's Disease Study Group, i.e. HD9, may be suggesting that conventional chemotherapy is producing good results in poor prognosis patients and thus negating the need for dose escalation and stem cell transplantation.