autologous blood and marrow transplantation - Blog Science ...

326 Chapter 6: Breast Cancer
An outpatient regimen
The design of our protocols has focused on the development of an acceptable
outpatient regimen. Unlike other high-dose regimens in which mucositis and
enterocolitis requiring parenteral nutrition or opioid analgesics are acceptable, we
designed these protocols such that severe mucositis and enterocolitis would be
dose-limiting toxicities so that it remained a suitable outpatient regimen. Although
the readmission rate was relatively high (78%), the length of stay in hospital was
relatively short at 5 days, and patients treated at level 4 or below did not require
opiate analgesia or parenteral nutrition for mucositis. This is of some importance,
as the regimen achieves substantial dose intensity (delivered every 28 days in 71%
of patients) but remains very much an outpatient therapy.
Hematopoietic recovery
We demonstrate that recovery of neutrophils to 1.0X10 9
/L and platelets to
50X10 9
/L is rapid and does not slow over the three cycles of therapy. However,
platelet recovery to 100X10 9
/L is progressively slowed. Basser et al. 46
have also
demonstrated that neutrophil and platelet recovery slows over three consecutive
cycles of high-dose epirubicin and cyclophosphamide. In their study, there was no
observable relationship between the autograft CFU-GM content and platelet and
neutrophil recovery. We, however, were able to demonstrate a correlation between
autograft CD34 +
cell content and neutrophil and platelet recovery. Furthermore,
this relationship (in terms of platelet recovery) is most evident when the autograft
has a low CD34 content (i.e.,