Factors affecting the outcome of autologous bone marrow transplantation

Various protocols have been used at Memorial Sloan-Kettering Cancer Center to improve the results of autologous bone marrow transplantation (ABMT) for hematopoietic malignancies. Results suggest that patients who undergo ABMT while in complete remission (after induction or reinduction treatment) do better than those who undergo ABMT in incomplete remission. In patients with relapsed or refractory lymphoma, the addition of etoposide to the total body irradiation/cyclophosphamide conditioning regimen has decreased the relapse rate from 53% to 7%. For patients with refractory or relapsed Hodgkin's disease, the dosages of different drugs can be altered to improve the overall success. Dose escalation of etoposide shows significant promise. Relapse after ABMT and/or toxic complications are the main factors that need to be addressed in the future. Pulmonary toxicity occurs mainly in patients with mediastinal disease. Factors that can decrease relapse rate and toxicity are discussed.