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

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TRIAL PROGRESS The trial opened in late summer 1988 and involves physicians from over 100 treatment centers in the UK, with a very important collaboration from New Zealand. By October 1992,1148 patients had entered. Of the 20% of trial entrants who were children (
sible in an environment where access to a transplant unit usually involved some delay. In the event, 9 patients who relapsed were autografted in relapse - only one survives, with relatively short follow-up. One of the early concerns was whether re-induction would be more difficult given that the first line treatment was much more intensive than in previous trials. Our previous trials had found a dominant effect of the length of first CR on the chances of entering remission. In fact this pattern of reinduction in AMLIO has been at least as good (duration of CR 12mo 78%). Within these subdivisions DAT or ADE was at least as successful as alternative, usually more aggressive or exotic, combinations (table 1). It should be pointed out that these data are not randomized and there may well be selection biases in what re-induction schedule was given. Of 170 patients who relapsed, of whom the statistical center is aware, 48 achieved a second CR. It should be noted that not all patients had an attempt at reinduction. Of the 48 CR2 patients, only 18 so far have received an auto BMT with a survival of around 30% on relatively short follow-up. This mimics the single center and registry experience. However, this was a selected patient group because 30 eligible patients did not receive the second CR autograft because of relapse (n=4) or early death (n=16) or were not considered fit. Ten of this group remain in CCR. This preliminary experience suggests that only a small number of patients who relapse in practice get to autograft. It therefore remains to be seen whether the adoption of a delayed transplant strategy will make any significant impact on survival in AML. OVERALL TRIAL OUTCOME No analysis relating to the major trial questions has so far been undertaken but is intended by late 1994. However, entrants to this trial are enjoying a significantly better outlook than MRC Trial entrants in the previous decade, even when the influence of the pediatric sub-group is allowed for, Such benefits over AML9 are apparent even if the transplanted groups are excluded from both trials. This suggests that the recipients of chemotherapy alone are enjoying an important benefit but until complete analysis is performed we are not in a position to know whether or not any of the BMT options bring additional benefit on top of that. Preliminary inspection has suggested certain subgroups of patients who are enjoying a better than average survival. These include those with an 8:21 or 15:17 translocation and patients who enter remission with the first course. Whether these are the same patient group is not yet clear. Nor does this infer that they do or do not derive benefit from a transplant option. But these could clearly be used as landmarks for more individually oriented risk-directed therapy in the future. Interestingly, the experience of the EBMT Group suggests that purging the autograft will not benefit patients who enter remission quickly, presumably because they already are a good risk group. Our 4 year accrual of 1150 patients has produced 950 patients in remission, of whom a subset of around 250 fail to enter remission promptly, and might, as one option for the future, benefit from a purging approach. This is approximately the patient number which would need to be recruited to a randomization to confirm, with sufficient statistical confidence, the apparent benefit of purging in this subgroup. SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 3
Page 1: Autologous Bone Marrow Transplantat
Page 5 and 6: CONTENTS nviAum TMLHTA'I OTT! 7 A l
Page 7 and 8: AUTOLOGOUS BONE MARROW TRANSPLANTAT
Page 9 and 10: TREATMENT OF NONSMALL CELL LUNG CAN
Page 11: SUMMARY OF THE NON HODGKIN LYMPHOMA
Page 15: Session I: Leukemia
Page 20 and 21: Table 1. Achievement of Second Remi
Page 22 and 23: ALLOGENEIC VERSUS AUTOLOGOUS BONE M
Page 24 and 25: pts). The other 56 pts are too earl
Page 26 and 27: Figure 1 EORTC-GIMEMA AML 8 A EORTC
Page 28 and 29: PATIENTS AND METHODS Patients The B
Page 30 and 31: Thus, as the results of some ongoin
Page 32 and 33: COMPARISON OF INTENSIVE CONSOLIDATI
Page 34 and 35: over, 13 pts who had received ICC1
Page 37: Session II: Future Directions
Page 40 and 41: in a previous report 3 . Analysis a
Page 42 and 43: Engraftment of granulocyte, monocyt
Page 44 and 45: 0.2 - 0.1 - ABMT with mAb purging f
Page 46 and 47: ENHANCED REGENERATION OF NATURAL KI
Page 48 and 49: RESULTS The in vivo immune effects
Page 50 and 51: 16. Rizzoli V, Mangoni L, Carlo-Ste
Page 52 and 53: hydroperoxycyclophosphamide (4HC)-t
Page 54 and 55: survival in patients undergoing ABM
Page 56 and 57: IMMUNOTHERAPY OF AML AFTER ABMT - S
Page 58 and 59: Otherwise toxicity was mild to mode
Page 60 and 61: 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
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METHODS Selection of patients and t
Page 82 and 83:
marrow treatment. Am J Med 85:829,1
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HIGH DOSE THERAPY WITH HEMATOPOIETI
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in TC 19 medium (Flobio), with an h
Page 88 and 89:
progression for a long time after A
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Table 2. STATUS AT GRAFT Remission
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IL Figura 3 70 SIXTH INTERNATIONAL
Page 94 and 95:
( 5 ) lowed by ABMT than refractory
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74 Figure 4 Low grade lymphoma - pr
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(range 15-55); 68 males and 32 fema
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our experience, this has a seven-ye
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30. Colombat P, Gorin NC, Lemonnier
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82 OVERALL SURUIWL from ABUT (accor
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PROGNOSTIC FACTORS IN ADVANCED STAG
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REFERENCES 1. Chopra R, Mc Millan A
Page 111 and 112:
lished data to attempt to assess th
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1992;10:175-7. 3. McMillan A, Golds
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B. DAILY DAY AGENT DOSE -7 -6 -5 -4
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cohort with HR treated with BEC-2 i
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p R 0 P O R T I 0 N 1 0.9 0.8 0.7 0
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TABLE 3. TOXICITY BEC TAVe TMJ as 2
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ies. 10 Longer blood half-lives hav
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agents have been developed cautious
Page 127 and 128:
Table 1. Radioisotopes for RIT. Pur
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The treatment criterion in this stu
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more than 80% of the cases. Patient
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Disease Free Survival 800 Time •
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Session VI: Breast Cancer
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achieved a complete remission survi
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acil, vincristine, prednisone (CMFV
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t: 3 en a in S « J •S •> c ai
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LONG TERM FOLLOW UP OF POOR PROGNOS
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tors both for progression-free surv
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222 INDUCTION PHASE ESTROGEN RECEPT
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THE PHARMACOLOGY OF INTENSIVE CYCLO
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PK VARIABILITY OF CPA/CDDP/BCNU Whe
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5. Groshow LB, Piantadosi S, Santos
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- Tn'üTiifi'.m'jii.'yjKJiHtyiwiT T
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normal CD34+ progenitor cells
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sequence analysis of the human haem
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Bielefeld, FRG) or control medium w
Page 165 and 166:
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
Page 171 and 172:
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
Page 177 and 178:
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
Page 191:
Session Mill: Lung Cancer
Page 194 and 195:
Of the 14 limited stage patients in
Page 196 and 197:
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
Page 204 and 205:
Table 2: Toxicity of CBP Regimen fo
Page 206 and 207:
TREATMENT OF NONSMALL CELL LUNG CAN
Page 208 and 209:
Table 1. Combination Chemotherapy R
Page 210 and 211:
Table 6. Hematological Data of the
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ence in survival among the three hi
Page 215:
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
Page 233:
Session X: Sarcoma
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ated doses in a recent Pediatric On
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cytokines to reduce hospitalization
Page 240 and 241:
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
Page 253:
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
Page 278 and 279:
6. Brugger W, Bross K, Frisch J, et
Page 280 and 281:
100 -l Collection Efficiency Figure
Page 282 and 283:
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
Page 291 and 292:
AUTOLOGOUS BONE MARROW TRANSPLANTAT
Page 293 and 294:
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
Page 303 and 304:
Leonard Kalman, Hematology/Oncology
Page 305:
D.R. Sutherland, Oncology Research,
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