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442 Chapter 7: Solid Tumors DISCUSSION The lack of optimal regimens for PBPC mobilization associated with the wide individual variability in mobilization yields are major factors supporting the need for the development of mobilization protocols aimed at improving the quantity and quality of collected PBPC. This randomized study demonstrates that addition of amifostine significantly increases the mobilization of CD34 + cells, primitive LTC-IC as well as lineagerestricted progenitors, in cancer patients receiving a regimen consisting of epirubicin + G-CSF. The lack of phenotypic differences between CD34 + cells mobilized without or with amifostine associated with the enhanced mobilization of LTC-IC demonstrates that amifostine-mediated release of CD34 + cells is not merely due to an increase of mature CD34 + cells. Interestingly, the enhancing effect of amifostine on mobilization was evident even in heavily pretreated patients. Similarly, enhanced mobilization was also evident in patients randomized to receive amifostine at the second cycle of epirubicin + G-CSF, thus suggesting a potential role of amifostine in poor mobilizers. A variety of mechanisms are likely to be involved in the transient release of progenitors into peripheral blood. Growth factors modulate cell adhesion molecule expression, extracellular matrix metabolism and ligand-receptor systems supporting progenitor cell adhesion to stroma. Chemotherapy is known to induce the disruption of marrow endothelial cell barriers. Different mobilization patterns displayed by chemotherapy-based regimens with different cytoreducing potential suggest an agent- and dose-dependent mobilization effect via the degree of induced myelosuppression. The selective mobilization of LTC-IC and clonogenic progenitors by chemotherapy-based regimens suggests that marrow aplasia might enhance PBPC mobilization potential, likely by affecting cell cycle induction and rate of primitive cells. Moreover, possible toxic effects of mobilizing agents or doses on the stromal/stem cell compartment might be relevant in determining the mobilization pattern of primitive progenitors. The mechanisms involved in amifostine-mediated enhancement of PBPC mobilization remain a matter of hypothesis. The well-known chemoprotection exerted by amifostine on progenitor cells following injection of a number of different chemotherapeutic agents 26-33 might play a major role in increasing the release of primitive and committed colony-forming cells. In fact, CD34 + cells and hematopoietic progenitors spared by amifostine could be released in the blood during the recovery phase after epirubicin + G-CSF. However, a modulating effect of amifostine on adhesion molecules could also be involved in improving mobilization and is currently under investigation. In the present study, amifostine was injected before epirubicin and for 4 days thereafter. While the rationale of injecting amifostine before chemotherapy is
Carlo-Stella et al. immediately evident and relies on the sparing action of amifostine on hematopoietic progenitors, injection of the drug after chemotherapy was based on the hypothesis that prolongation of amifostine injection might eventually result in an in vivo stimulation of hematopoiesis, as has been shown in patients with myelodysplastic syndromes. 39 We are currently testing whether post-chemotherapy amifostine administration could be started on day 7 after chemotherapy to further improve the mobilizing efficacy. In conclusion, this randomized study demonstrates that addition of amifostine to epirubicin + G-CSF significantly increases the mobilization of CD34 + cells and primitive and committed progenitors in pretreated cancer patients. We are currently investigating the mechanism(s) of action of amifostine as well as the efficacy of different schedules. ACKNOWLEDGMENTS This work was supported in part by grants from "Ministero deU'Università e della Ricerca Scientifica e Tecnológica" (MURST—40 and 60%), "Associazione Italiana per la Ricerca sul Cancro" (A.I.R.C.), and "Associazione Italiana Leucémie (A.I.L.)—Trenta Ore per la Vita." D.G. is supported by a grant from the Azienda Ospedaliera di Parma; E.R. is a recipient of an A.I.R.C. fellowship. REFERENCES 1. Appelbaum FR: Marrow transplantation for hematologic malignancies: A brief review of current status and future prospects. Semin Hematol 25 (Suppl 3): 16-22,1988. 2. Chopra R, Goldstone AH: Modern trends in bone marrow transplantation for acute myeloid and acute lymphoblastic leukemia. Curr Opin Oncol 4:247-258, 1992. 3. Santos GW, Yeager AM, Jones RJ: Autologous bone marrow transplantation. Ann Rev Med 40:99-112,1989. 4. Armitage JO: Bone marrow transplantation. N Engl J Med 330:827-838,1994. 5. Gianni AM: Where do we stand with respect to the use of peripheral blood progenitor cells? Ann Oncol 5:781-784, 1994. 6. Advisory Committee of the International Autologous Bone Marrow Transplant Registry: Autologous bone marrow transplant. Different indications in Europe and North America. Lancet ii:317-321,1989. 7. Hillyer CD, Wells SJ: Alternative sources of hematopoietic stem cells for bone marrow transplantation and rescue. J Hematother 2:491-499,1993. 8. Eaves CJ: Peripheral blood stem cells reach new heights. Blood 82:1957-1959,1993. 9. Schmitz N, Linch DC, Dreger P, Goldstone AH, Boogaerts MA, Ferrant A, Demuynck HM, Link H, Zander A, Barge A: Randomised trial of filgrastim: Mobilised peripheral blood progenitor cell transplantation versus autologous bone marrow transplantation in lymphoma patients. Lancet 347:353-357, 1996. 443
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AUTOLOGOUS BLOOD AND MARROW TRANSPL
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AUTOLOGOUS BLOOD AND MARROW TRANSPL
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ACKNOWLEDGMENTS We wish to thank Wi
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THE VAN BEKKUM STEM CELL AWARD Prof
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xii Table of Contents CHAPTER 2: AL
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xiv Table of Contents Late Non-Rela
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xvi Table of Contents Pretreatment
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xviii Table of Contents CHAPTER 7:
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XX Table of Contents Long-Term Obse
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xxii Table of Contents CHAPTER 13:
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0-9 LIST OF ABBREVIATIONS 2CDA 2-ch
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List of Abbreviations xxvii EFS eve
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List of Abbreviations MOPP mechlore
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VOD veno-occlusive disease VPC viru
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4HC-Purged Autologous Stem Cell Tra
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1.0-1 + 0.2 Miller et al. 5 Event F
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Miller et al. Adjusted probability
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Who Benefits From Autograft in AML
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Burnett 11 which to set the transpl
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Table 1. Outcome after relapse in M
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Immunotherapy in AML: No Positive E
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Simonsson et al. inhibit IL-2 induc
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Autologous Bone Marrow Transplantat
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Ball et al. 21 CD15) and AML-2-23 (
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Ball et al. 23 The ex vivo treatmen
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Ball et al. 25 Table 2. Factors inv
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Ball et al. Overall Survival for Pa
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Ball et al. Overall Survival for Pa
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Ball et al. 31 Overall Survival for
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Ball et al. Table 4. Actuarial over
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Ball et al. myeloid leukemia. The G
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Ball et al. 1993. 38. Mehta J, Powl
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Can Autologous Stem Cell Transplant
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De Witte et al. 41 novo AML. Auer r
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De Witte et al. hematopoietic engra
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De Witte et al. 23. Fenaux P, Laï
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Stein et al. and fever. No patient
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Stein et al. after doses 1, 3, and
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Stein et al. early after the transp
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autologous stem-cell rescue. / Clin
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Bone Marrow Transplantation for Acu
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Table 2. Autologous BMT in ALL in f
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Rowe 61 or adult patients with acut
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Hoelzer and Gôkbuget minitransplan
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Hoelzer and Gdkbuget 65 blood, earl
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Table 3. Risk factors for the defin
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Hoelzer and Gôkbuget treatment opt
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Hoeker and Gökbuget tical sibling
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Sierra et al. INTRODUCTION Two-thir
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Sierra et al. Table 2. Adverse char
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1,0 0,0 J Sierra et al. 0 20 40 60
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Sierra et al. Months Figure 4 < 30,
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Sierra et al. No adverse factors (n
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1994. Sierra et al. 83 10. Canals C
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Martin, Atta, and Hoelzer 85 adult
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Martin, Atta, and Hoelzer 87 Single
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100. Martin, Atta, and Hoelzer 89 P
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Martin, Atta, and Hoelzer 91 chromo
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Autologous vs. Unrelated Allogeneic
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Boyer and Yeager 95 outcomes after
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Boyer and Y eager 97 Table 2. Hypot
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Boyer and Y eager SUMMARY Most of t
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CHAPTER 3 CML
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Autograft Followed by Allograft Wit
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106 Chapter 3: CML (one low-grade a
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108 Chapter 3: CML DISCUSSION Myelo
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110 Chapter 3: CML Philadelphia-neg
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The Case for Manipulation of CML Au
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Toward a Cure by Drug Treatment? Th
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116 Chapter 3 :CML Table 1. Prolong
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118 Chapter 3: CML Table 3. German
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120 Chapter 3: CML Table 5. Normal
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122 Chapter 3: CML Table 8. Surviva
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124 Chapter 3: CML 88:3118-3122, 19
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126 Chapter 3: CML RK, Klingemann H
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The Tyrphostin AG957 Inhibits the I
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130 Chapter 3: CML mobilization. Al
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132 Chapter 3: CML A B 100 n 0 1 5
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134 Chapter 3: CML The in vitro sel
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136 Chapter 3: CML detecting leukem
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Progressive Hodglcin's Lymphoma Fol
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Reece et al. survival is observed i
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0.2 -I 0.0 0 Reece et al. 143 ii i
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Reece et al. Table 3. Causes of non
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Reece et al. carmustine, etoposide
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CD34 + Selection of Hematopoietic B
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Lazarus et al. 151 significantly de
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Lazarus et al. 153 (Sigma, St Louis
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Lazarus et al. 155 Table 2. Effect
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Lazarus et al. 157 difference. Furt
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Lazarus et al. 159 cells after myel
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The European CUP/UP Trial: A Prelim
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Table 1. Patient characteristics at
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Schouten et al. licular non-Hodgkin
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Sweetenham et al. vs. autologous pe
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Table 1. Patient characteristics, g
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Table 2. Patient characteristics, g
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Table 3. Sites of relapse, group A
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Table 4. Patterns of relapse, group
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A 100 80 %OS 60 40 20 B 100 %OS | S
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Sweetenham et al. new sites, and fi
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Sweetenham et al. Treatment options
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Molecular Remission: A Worthwhile A
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Early or Late Autotransplant in Hig
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Schenkein et al. 187 PATIENTS AND M
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Schenkein et al. 189 Toxicity Toxic
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Schenkein et al. 191 16. Glick JH,
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Santini et al. 193 to evaluate the
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Table 1. Continued Santini et al. 1
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Santini et al. 197 cytosine arabino
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1 0 0 1 90- 80- 70- (0 u. 60' o so-
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Hodgkin's lymphoma. N EnglJ Med 333
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CHAPTER 5 MYELOMA
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206 Chapter 5: Myeloma independent
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208 Chapter 5: Myeloma disease (MRD
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210 Chapter 5: Myeloma Scandinavia,
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212 Chapter 5: Myeloma (0 n o B co
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214 Chapter 5: Myeloma B cq d ? o c
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216 Chapter 5: Myeloma patients wit
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218 Chapter 5: Myeloma PBSC transpl
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220 Chapter 5: Myeloma 25. Seiden M
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Autologous Transplantation in Multi
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224 Chapter 5: Myeloma 0 52 44 U §
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226 Chapter 5: Myeloma BM ^ (CD34±
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228 Chapter 5: Myeloma IFM 94 : OS
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230 Chapter 5: Myeloma two groups a
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232 Chapter 5: Myeloma increase bot
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234 Chapter 5: Myeloma REFERENCES 1
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236 Chapter 5: Myeloma Intensified
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238 Chapter 5: Myeloma of CD34 + ce
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Chapter 5: Myeloma Table 2. Descrip
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242 Chapter 5: Myeloma o 8H 0 2 4 6
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244 Chapter 5: Myeloma ated with sh
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The Presence of Micrometastases in
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Kvalheim et al. 249 Table 1. Immuno
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Kvalheim et al. 251 Figure 1. Sixty
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Kvalheim et al. 253 DISCUSSION In t
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Kvalheim et al. 255 Bastert G: Micr
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Hood et al. 257 In an effort to inc
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#CD34 + cells in blood = Hood et al
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Hood et al. 261 Table 3. Frequency
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Hood et al. 263 REFERENCES 1. Rill
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The Clinical Significance of Breast
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Moss et al. tests, and bilateral po
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Moss et al. 269 0 15 70 143 200 400
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Moss et al. 271 0 3 6 12 18 24 30 3
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Moss et al. 273 8. Passos-Coelho J,
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Autotransplantation for Men With Br
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McCarthy et al. 277 radiation, two
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High Dose Sequential Chemotherapy W
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Viens et al. 281 3 g/m 2 and doxoru
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Table 1. Tumor characteristics Exte
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Table 4. Response Viens et al. 285
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Viens et al. 287 Table 5. Pathologi
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Viens et al. 289 apy for inoperable
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Gliick et al. 291 INTRODUCTION The
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Gluck et al. 293 RESULTS Patient de
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Glück et al. 295 Table 3. Response
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Gluck et al. 297 Overall Survival O
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Gluck et al. 299 Sudbury patients w
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Gluck et al. 301 anthracycline or t
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Repetitive High-Dose Therapy With P
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Prince et al. paramagnetic separati
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Prince et al. Table 1. High-dose re
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Table 2. Patient characteristics (n
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Table 4. Hematopoietic recovery fol
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1.0- M C .S 0.8- a c *fe o o> 0.6-
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M 1.0 I 0.8H s? VI o.6H S 0.2 0.0 P
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a Prince et al. days to platelets >
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Table 5. Results of Isolex 300i CD3
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Prince et al. 321 Figure 5, continu
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Prince et al. 323 months after tran
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Prince et al. 325 excessive to be u
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Prince et al. 327 eight patients ha
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Prince et al. 329 marrow transplant
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Prince et al. intensive chemotherap
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-Q CO .Q O 1.0 0.9 0.8 0.7 0.6 0.5
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.Q CD .Q O 1.0 0.9 0.8 0.7 0.6 0.5
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oba Q. 1.0 0.9 Dicke et al. Stage I
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Vahdat with peripheral blood progen
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Evaluation of Prognostic Factors fo
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Fields et al. 343 PATIENTS AND METH
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Table 1. Chemotherapy regimens. Fie
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Fields et al. Stage II; 4-9 Pos LN
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U U Fields et al.
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Fields et al. 351 between 1 and 2 y
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European Trends and the EBMT Databa
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25% % 22% / 17% \ Rosti et al. 355
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Rosti et al. 357 The new Italian St
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Rosti et al. 6. Haas R, Schmid H, H
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Bewick et al. 363 INTRODUCTION The
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Bewick et al. 365 Blood samples obt
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Bewick et al. 367 HDCT with ABSC su
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Bewick et al. Progression Free Surv
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Bewick et al. pression in MBC, i.e.
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Bewick et al. 14. Kandl HL, Seymour
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CHAPTER 7 OTHER SOLID TUMORS
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378 Chapter 7: Solid Tumors INTRODU
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380 Chapter 7: Solid Tumors Prepara
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382 Chapter 7: Solid Tumors Surviva
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384 Chapter 7: Solid Tumors months
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386 Chapter 7: Solid Tumors have be
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High-Dose Chemotherapy in the Manag
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390 Chapter 7: Solid Tumors followe
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Page 430 and 431: Three-Fold Intensification by Seque
Page 436 and 437: High-Dose Therapy for Small Cell Lu
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Page 446 and 447: 412 Chapter 7: Solid Tumors ogous b
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Page 456 and 457: Multiple Courses of Cyclophosphamid
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Page 466 and 467: 432 Chapter 7: Solid Tumors course
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Page 472 and 473: 438 - Chapter 7: Solid Tumors Table
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Page 483 and 484: Autologous Stem Cell Transplantatio
Page 485 and 486: Keystone 451 hypertension, anemia,
Page 487 and 488: Fassas et al. 453 INTRODUCTION Mult
Page 489 and 490: Fassas et al. Table 2. Stem cell mo
Page 491 and 492: Table 3. Toxicity after stem cell i
Page 493 and 494: Fassas et al. Table 5. Trial 1: cha
Page 495 and 496: Fassas et al. MS PROGRESSION FREE S
Page 497 and 498: Fassas et al. ic or autologous bone
Page 499 and 500: 1 2 1 6 EAE. Burt et al. 465 Becaus
Page 501 and 502: Burt et al. Since cyclophosphamide
Page 503 and 504: Burt et al. 469 toxicity study, we
Page 505 and 506: Burt et dl. All 23. Mor F, Cohen IR
Page 507 and 508: Hasler, Gratwohl, and Tyndall an ev
Page 509 and 510: Hasler, Gratwohl, and Tyndall 475 B
Page 511 and 512: Kuis, Wulffraat, and Sanders 477 st
Page 513 and 514: Kuis, Wulffraat, and Sanders neousl
Page 515: CHAPTER 9 LONG-TERM EFFECTS
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492 Chapter 9: Long-Term Effects us
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494 Chapter 9: Long-Term Effects AB
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496 Chapter 9: Long-Term Effects Ta
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498 Chapter 9: Long-Term Effects En
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500 Chapter 9: Long-Term Effects Rl
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502 Chapter 9: Long-Term Effects RE
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504 Chapter 9: Long-Term Effects A,
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Long-Term Follow-Up of Autologous T
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508 Chapter 9: Long-Term Effects Ta
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CHAPTER 10 GRAFT MANIPULATION
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514 Chapter 10: Graft Manipulation
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Stem Cell Reinfusion Over Two Conse
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Final Report of the First Prospecti
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Canine Hematopoietic Stem Allograft
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Sandmaier et al. 603 The resultant
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Sandmaier et al. 605 synthesis path
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Sandmaier et al. 607 interactions o
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Sandmaier et al. 1991. 2. Burchenal
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87:3508-3513,1996. Sandmaier et al.
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Giralt, Khouri, and Champlin Table
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Giralt, Khouri, and Champlin seven
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1.0 3 0.2 Giralt, Khouri, and Champ
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CHAPTER 12 GENE THERAPY
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622 Chapter 12: Gene Therapy INTROD
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624 Chapter 12: Gene Therapy RESULT
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626 Chapter 12: Gene Therapy envisi
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628 Chapter 12: Gene Therapy cer in
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A Vaccine of Melanoma Peptide Loade
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B43(anti-CD 19)-Gen i stein Immunot
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Targeting Immunotherapy for the Tre
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McGuinness andArceci 637 modified m
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McGuinness andArceci 639 leukemic c
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McGuinness and Arced 641 in G418. T
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McGuinness andArceci 643 Figure 2
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mRNA for hB7-1 (1491 bp) mRNA for C
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McGuinness and Arced CD80PE C080PE
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McGuinness andArceci 649 8. Robert
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McGuinness andArceci immune respons
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McGuinness andArceci 75. Jubinsky F
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Slavin et al. 655 up suggests, as p
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Slavin et al. 657 was a phase lib c
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Slavin et al. presented, appears to
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Antitumor Immunotherapy in Autologo
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Klingemann et al. 663 Table 3. Meth
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CHAPTER 14 RADIOIMMUNOTHERAPY
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668 Chapter 14: Radioimmunotherapy
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Selection of Radioisotopes, Chelate
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Radioimmunotherapy of Common Epithe
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CHAPTER 15 NEW AVENUES
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698 Chapter 15: New Avenues Table 1
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700 Chapter 15: New Avenues An alte
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702 Chapter 15: New Avenues who can
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704 Chapter 15: New Avenues myeloid
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706 Chapter 15: New Avenues 48. Gir
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Emerging Viral Infections in Blood
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710 Chapter 15: New Avenues influen
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712 Chapter 15: New Avenues Among a
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714 Chapter 15: New Avenues physica
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716 Chapter 15: New Avenues respira
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Minimal Therapy Models of Transplan
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CHAPTER 16 SUMMARIES
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724 Chapter 16: Summaries although
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726 Chapter 16: Summaries use of po
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728 Chapter 16: Summaries Table 1.
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736 Chapter 16: Summaries IL-15. Th
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738 Chapter 16: Summaries Patterns
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740 List of Participants Thomas L.
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742 List of Participants Sergio A.
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744 List of Participants Hans Marti
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746 List of Participants David P. S
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748 List of Participants AUTHOR IND
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750 Author Index Hurd, D.D. 483 Kui
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752 Author Index Stiff, Patrick J.
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754 Key Word Index Hematologic mali
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ISBN 1-891524-04-6
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