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"unstimulated" 11 peripheral blood cells. No post-transplant therapy was given until definite progression occurred. Eighteen patients received planned qrowth factor support post-AuBMT.12 RESULTS All but 2 patients had recovery of the absolute neutrophil count (ANC) > 0.5 x 10VL on a median of day +16 (range +9 to +33) post-AuBMT. Fifty-three patients became independent from platelet transfusions on a median of day +19 (range +6 to +103). (As expected, patients receiving hematopoietic growth factors generally had the more rapid ANC recoveries. 12) At present, 42 of these 58 patients are alive and disease-free, almost all with Karnofsky scores of 100%. Conversely, 13 patients relapsed and 3 suffered nonrelapse mortality. Actuarial progression-free survival is 64% at 6 years (95% CI 47% to 80%) (Figure 3). Of analyzed factors, the presence of "B" symptoms at the time of AuBMT (p < 0.001) and an initial progression-free interval of < 12 months following primary chemotherapy (p = 0.025) were significant adverse prognostic factors in multivariate testing. (As noted above, this result was similar - althouqh not identical - to one obtained after analyzing all 53 B.C. patients in first untested relapse, regardless of treatment, between 1970 and 1988. 13 ) The results in patients classified by a lymphoma-free interval of > versus < 12 months is of interest, as such is often used to determine whether or not patients should proceed to AuBMT; the former had -30% and the latter -85% subsequent progression-free survival post-AuBMT. CONCLUSIONS The most definitive way to evaluate whether first untested relapse (as compared to any tested relapse) is indeed the proper timing for HD is to perform an appropriate randomized clinical trial. However, for a number of reasons, such a trial is unlikely to be performed - at least in the near future. Our results encourage us to consider first untested relapse as the current optimal timing for AuBMT in most patients. Of course, many patients transplanted in first untested relapse are not cured, especially those with the adverse prognostic factors noted above, and it is important to consider new ways of treating such "high-risk" patients which will reduce relapses post-AuBMT without producing an excessive number of deaths due to toxicity. Various methods to upgrade conditioning regimens are being evaluated;14 an alternative approach would be the development and verification of post-AuBMT immunomodulation. 15 Although perhaps more controversial, the reliable identification of patients at extremely high risk of relapse during their initial remission would permit the use of the AuBMT procedure as "consolidation" after primary therapy. Such an approach has been pursued by Carella, et all 6 and has produced favorable preliminary results, but these require confirmation. Each approach has certain advantages and disadvantages and should be tested further. REFERENCES 1. Armitage JO. Bone marrow transplantation in the treatment of patients with lymphoma. Blood 1989;73:1749-58. 2. Canellos GP. The second chance for advanced Hodgkin's disease. J Clin Oncol 88 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION
1992;10:175-7. 3. McMillan A, Goldstone A. What is the value of autologous bone marrow transplantation in the treatment of relapsed or resistant Hodgkin's disease? Leuk Res 1991;15:237-43. 4. Phillips GL, Reece DE, Connors JM. Bone marrow transplantation in Hodgkin's disease. Bone Marrow Transplant 1992;10(Suppl l):64-6. 5. Desch CE, Lasala MR, Smith TJ, et al. The optimal timing of autologous bone marrow transplantation in Hodgkin's disease patients after a chemotherapy relapse. J Clin Oncol 1992;10:200-9. 6. Buzaid AC, Lippman SM, Miller TP. Salvage therapy of advanced Hodgkin's disease: Critical appraisal of curative potential. Am J Med 1987:83:523-32. 7. Longo DL, Duffey PL, Young RC et al. Conventional-dose salvage combination chemotherapy in patients relapsing with Hodgkin's disease after combination chemotherapy: The low probability for cure. J Clin Oncol 1992;10:210-8. 8. Reece DE, Barnett MJ, Connors JM et al. Intensive chemotherapy with cyclophosphamide, carmustine, and etoposide followed by autologous bone marrow transplantation for relapsed Hodgkin's disease. J Clin Oncol 1991;9:1871-9. 9. Harden E, Bolwell B, Fay J et al. Treatment of progressive Hodgkin's disease (HD) with cyclophosphamide (C), BCNU (B) and continuous infusion etoposide (V): CBVi and autologous marrow transplantation (AMT) [abstract]. Proc Am Soc Clin Oncol 1990;9:271. 10. Wheeler C, Antin JH, Churchill WH et al. Cyclophosphamide, carmustine, and etoposide with autologous bone marrow transplantation in refractory Hodgkin's disease and non-Hodgkin's lymphoma: A dose-finding study. J Clin Oncol 1990;8:648-56. 11. Kessinger A, Armitage JO, Smith DM, et al. High-dose therapy and autologous peripheral blood stem cell transplantation for patients with lymphoma. Blood 1989;74:1260-5. 12. Klingemann H-G, Eaves AC, Onetto N et al. Randomized trial of GM-CSF (2 hour versus 24 hour infusion) after autologous bone marrow transplantation (AuBMT) for Hodgkin's disease [abstract]. Exp Hematol 1991;19:558. 13. Lohri A, Barnett M, Fairey RN et al. Outcome of treatment of first relapse of Hodgkin's disease after primary chemotherapy: Identification of risk factors from the British Columbia experience 1970 to 1988. Blood 1991;77:2292-8. 14. Gianni AM, Siena S, Bregni M et al. Prolonged disease-free survival after high-dose sequential chemo-radiotherapy and haemopoietic autologous transplantation in poor prognosis Hodgkin's disease. Ann Oncol 1991;2:645-53. 15. Jones RJ, Vogelsang GB, Hess AD et al. Induction of graft-versus-host disease after autologous bone marrow transplantation. Lancet 1989;1:754-7. 16. Carella AM, Carlier B, Congiu A et al. Autologous bone marrow transplantation as adjuvant treatment for high-risk Hodgkin's disease in first complete remission after MOPP/ABVD protocol. Bone Marrow Transplant 1991:8:99-103. SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 89
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Autologous Bone Marrow Transplantat
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CONTENTS nviAum TMLHTA'I OTT! 7 A l
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AUTOLOGOUS BONE MARROW TRANSPLANTAT
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TREATMENT OF NONSMALL CELL LUNG CAN
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SUMMARY OF THE NON HODGKIN LYMPHOMA
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Session I: Leukemia
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TRIAL PROGRESS The trial opened in
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Table 1. Achievement of Second Remi
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ALLOGENEIC VERSUS AUTOLOGOUS BONE M
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pts). The other 56 pts are too earl
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Figure 1 EORTC-GIMEMA AML 8 A EORTC
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PATIENTS AND METHODS Patients The B
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Thus, as the results of some ongoin
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COMPARISON OF INTENSIVE CONSOLIDATI
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over, 13 pts who had received ICC1
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Session II: Future Directions
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in a previous report 3 . Analysis a
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Engraftment of granulocyte, monocyt
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0.2 - 0.1 - ABMT with mAb purging f
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ENHANCED REGENERATION OF NATURAL KI
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RESULTS The in vivo immune effects
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16. Rizzoli V, Mangoni L, Carlo-Ste
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hydroperoxycyclophosphamide (4HC)-t
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survival in patients undergoing ABM
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IMMUNOTHERAPY OF AML AFTER ABMT - S
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Otherwise toxicity was mild to mode
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Therapy. Amsterdam Elsevier 1987;89
Page 62 and 63: 200 IL6 in serum 44 SIXTH INTERNATI
Page 64 and 65: sodes), fewer days of i.v. antibiot
Page 67: Session III: Myeloma
Page 70 and 71: trary, in case of adequate collecti
Page 72 and 73: tion is considered, and all the mor
Page 74 and 75: Table 3: Cost effectiveness of high
Page 77: Session W: Lymphoma
Page 80 and 81: METHODS Selection of patients and t
Page 82 and 83: marrow treatment. Am J Med 85:829,1
Page 84 and 85: HIGH DOSE THERAPY WITH HEMATOPOIETI
Page 86 and 87: in TC 19 medium (Flobio), with an h
Page 88 and 89: progression for a long time after A
Page 90 and 91: Table 2. STATUS AT GRAFT Remission
Page 92 and 93: IL Figura 3 70 SIXTH INTERNATIONAL
Page 94 and 95: ( 5 ) lowed by ABMT than refractory
Page 96 and 97: 74 Figure 4 Low grade lymphoma - pr
Page 98 and 99: (range 15-55); 68 males and 32 fema
Page 100 and 101: our experience, this has a seven-ye
Page 102 and 103: 30. Colombat P, Gorin NC, Lemonnier
Page 104 and 105: 82 OVERALL SURUIWL from ABUT (accor
Page 107 and 108: PROGNOSTIC FACTORS IN ADVANCED STAG
Page 109 and 110: REFERENCES 1. Chopra R, Mc Millan A
Page 111: lished data to attempt to assess th
Page 115 and 116: B. DAILY DAY AGENT DOSE -7 -6 -5 -4
Page 117 and 118: cohort with HR treated with BEC-2 i
Page 119 and 120: p R 0 P O R T I 0 N 1 0.9 0.8 0.7 0
Page 121 and 122: TABLE 3. TOXICITY BEC TAVe TMJ as 2
Page 123 and 124: ies. 10 Longer blood half-lives hav
Page 125 and 126: agents have been developed cautious
Page 127 and 128: Table 1. Radioisotopes for RIT. Pur
Page 129 and 130: The treatment criterion in this stu
Page 131 and 132: more than 80% of the cases. Patient
Page 133 and 134: Disease Free Survival 800 Time •
Page 135: Session VI: Breast Cancer
Page 138 and 139: achieved a complete remission survi
Page 140 and 141: acil, vincristine, prednisone (CMFV
Page 142 and 143: t: 3 en a in S « J •S •> c ai
Page 144 and 145: LONG TERM FOLLOW UP OF POOR PROGNOS
Page 146 and 147: tors both for progression-free surv
Page 148 and 149: 222 INDUCTION PHASE ESTROGEN RECEPT
Page 150 and 151: THE PHARMACOLOGY OF INTENSIVE CYCLO
Page 152 and 153: PK VARIABILITY OF CPA/CDDP/BCNU Whe
Page 154 and 155: 5. Groshow LB, Piantadosi S, Santos
Page 157 and 158: - Tn'üTiifi'.m'jii.'yjKJiHtyiwiT T
Page 159 and 160: normal CD34+ progenitor cells
Page 161 and 162: sequence analysis of the human haem
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Bielefeld, FRG) or control medium w
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3. Koeffler HP, and Golde DW: Chron
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ply infected with supernatants from
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controls must be carefully matched
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Fig. IB: GPI isozyme analysis of 2
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PROCESSING OF STEM CELLS FOR TRANSP
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in progress using marker genes to l
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Table 1. Factors Affecting Quality
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Figure 2 .2 A Refractory/Relapsed L
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HIGH DOSE CHEMOTHERAPY IN GERM CELL
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carboplatin and etoposide with auto
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HIGH DOSE THERAPY IN GERM CELL TUMO
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Confusing data come out from early
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Session Mill: Lung Cancer
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Of the 14 limited stage patients in
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esponses with persistent nodular di
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hanced, detection of initial failur
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Cellules. Bull Cancer 1987;74:587-5
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30 36 42 48 54 60 66 72 78 84 12 18
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Table 2: Toxicity of CBP Regimen fo
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TREATMENT OF NONSMALL CELL LUNG CAN
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Table 1. Combination Chemotherapy R
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Table 6. Hematological Data of the
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ence in survival among the three hi
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Session IX: Ovarian Cancer
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lymph node involvement or parenchym
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higher frequencies of neurotoxicity
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12. Ovarian Cancer Meta-Analysis Pr
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Table 2. Randomized Trials Employin
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BONE MARROW TRANSPLANTATION FOR OVA
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1). Data from the survey was combin
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carboplatinum and ifosfamide. The s
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Session X: Sarcoma
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ated doses in a recent Pediatric On
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cytokines to reduce hospitalization
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TABLE 2 Dose Escalation Schedule Do
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CHRONIC MYELOGENOUS LEUKEMIA WITH B
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DISCUSSION In this study, the use o
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AUTOGRAFTING IN CHRONIC MYELOID LEU
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Table 1 Remission Deaths Graft Hema
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16 (800 mg/m2 per day for two conse
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Session XII: CNS
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1.2 Description of the study The tr
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3. Conclusion In conclusion, treatm
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3. Conclusion Hematological toxicit
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Session XIII: Peripheral Stem Cells
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Crouse, 1992). In the present repor
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with no evidence of systemic diseas
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Administration of rhSCF at doses of
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In summary, the ligand for c-kit ha
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AUTOGRAFTING WITH G-CSF-MOBILIZED B
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cells and CD34+ cells observed in t
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6. Brugger W, Bross K, Frisch J, et
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100 -l Collection Efficiency Figure
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MATERIALS AND METHODS PATIENTS. Pat
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None of the patients included in ar
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9. Aurer I, Ribas A, Gale RP. What
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246 o 0.6 b 0.1 B1 Figure 2 p = 0.0
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AUTOLOGOUS BONE MARROW TRANSPLANTAT
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SUMMARY OF THE NON HODGKIN LYMPHOMA
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SUMMARY: AUTOLOGOUS MARROW TRANSPLA
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mor. The obverse of this coin is po
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treated at Memorial Hospital in New
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Contributors and Participants Tause
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Leonard Kalman, Hematology/Oncology
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D.R. Sutherland, Oncology Research,
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