VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

throughout their hospital stay and therapeutic antibiotic therapy as necessary.
Patients were discharged from the hospital when their absolute granulocyte
count was more than 500/ml for 2 consecutive days. Growth factor support was
not utilized in the first few patients, but when subsequently available, recombinant
human granulocyte colony stimulating factor (G-CSF) was routinely dispensed
either as an i.v. infusion over 4-6 h or as a subcutaneous injection once
daily in a dose of 5-10mg/kg body weight.
Response Criteria
Patients were seen and reevaluated at least monthly for 3 months after BMT.
A complete clinical and radiological restaging was performed immediately
upon hematologic reconstitution and again at 3 months after transplant and
then every 3 months for 1 year; this was repeated every 4 months during year 2
and then every 6 months or as clinically indicated during years 3 and 4. In patients
who remained progression-free, subsequent restaging procedures were
performed annually. CR was defined as disappearance of all clinical and radiological
evidence of disease for a minimum of 8 weeks. PR was defined as a 50%
or more decrease in the sum of the products of the diameters of all measurable
lesions persisting for at least 8 weeks. Anything less was considered a treatment
failure. Early death was defined as death within the first 30 days after transplant
and precluded assessment of disease response.
RESULTS
Thirteen of the 38 treated patients achieved a CR remission and 5 patients
had a PR for an overall response rate of 47% (Table 2). Four of the 17 patients
who had induction-therapy-resistant disease obtained a CR with MVT and 3
additional patients in this group realized a PR. With a minimum follow-up of 6
months, the median time to progression for the 18 responding patients was 14
months (Fig. 1). Six patients remained in CR at 8+, 15+, 18+, 21+, 46+, and 46+
months. Three of the 5 patients who remained in CR after 12 months were initial
induction failures. The median survival for all patients receiving MVT was 16
months (Fig. 2).
Seventeen patients failed to respond to MVT and 3 patients who died from
treatment-related complications were regarded as inevaluable. One patient died
of respiratory failure 37 days after the transplant. She had no evidence of
Hodgkin's disease at autopsy. This patient had received CBV with ABMT less
than 15 months prior to MVT and had also completed a course of palliative radiation
therapy to the chest (total dose 46 Gy) less than 6 months prior to receiving
the MVT regimen. One patient died in CR at 10 months after the transplant
from complications of a (possibly secondary) myelodysplastic syndrome. Three
patients died within the first 30 days of the transplant of alpha-streptococcal septicemia
(day 7), pulmonary hemorrhage (day 17) and aspergillus pneumonia
(day 27). These 3 early deaths and the patient who died on day 37 from progressive
pulmonary failure were considered therapy-related. Thus, the risk of treatment-related
mortality is about 10% with the MVT regimen.
Severe mucositis, necessitating continuous i.v. opiate analgesia and parenteral
nutrition for 7-14 days, was the dose-limiting toxicity and it occurred in
106 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION