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

marrow support with or without peripheral stem cells has been included in the
CVP protocol. Eleven patients have been entered in the study. Patient characteristics
are outlined in Table 3. It can be noted that the median age is 64, all patients
are smokers and 3 patients suffer from severe COPD. All patients were
diagnosed with stage III or IV disease. In Table 4, the overall results of the VP-
16/Platinol program have been listed. The response rate is 72% and the median
survival time is 7+ months. The median progression-free survival is 7+ months.
Three patients achieved complete remission on the basis of radiographic and CT
scan analysis, 6 patients achieved objective response, in 3 patients disease was
stable, and in 1 patient no tumor response was noted. At the moment, no difference
in survival between the various groups is evident except the patient with
the nonresponding tumor who died four months after onset of treatment.
Hematologic toxicity was acceptable as has been outlined in Tables 4 and 5.
The WBC nadir was not lower than 1500, whereas the median platelet nadir was
not less than 40,000/mm3. It is remarkable that the WBC nadir after the second,
third and fourth course was higher than after the first course. In one patient, a
catheter-related bacterial infection was noted, responding to antibiotic treatment.
Several patients needed red blood cell transfusions and the need for platelet
transfusions was minimal, see Table 5. Of the patients who had objective response
to the first three courses of VP-16/Platinol, marrow and peripheral stem
cells were harvested. Since most patients had compromised pulmonary function,
and also for economic reasons, marrow was harvested under local anesthesia
on an outpatient basis. Eight hundred cc of marrow was harvested in two
different sessions. The results of marrow harvest have been documented in
Table 6. It appears that the yield in terms of nucleated cells, GM-CFC and CD34positive
cells is not significantly different from the marrow cell suspension harvested
under general anesthesia. In the outpatient setting, 30-60 cc per puncture
site was collected when no more than 30 cc in the inpatient setting was collected.
The procedure is very well tolerated with minimal discomfort for the patient.
The total cost per outpatient marrow collection is $800 (one dollar per cc marrow),
whereas the costs for the inpatient procedure is over $5000. Several patients
have been enrolled in the intensification part of the program, the results
are too early to evaluate. So far the program is very well tolerated.
In conclusion, the intensive VP-16/Platinol program has promising results
and will form the basis of treatment of NSCLC. The role of intensification with
three additional courses of Platinol-based chemotherapy of which the last course
is in conjunction with hematopoietic stem cell support is under evaluation. The
next step is to evaluate the feasibility of radiotherapy added to VP-16/Platinol in
a fractionated fashion as has been outlined by Dr. Woo in this session.
REFERENCES
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2. Mackay B. Current Opinion in Oncology 1990,2:316-320.
3. Evans WK. Semin Oncol 1988,15:42-45.
4. Tisman, et al. J Amer Soc Clin Oncol 1984,3:27.
5. Gralla RJ, et al. Ann Int Med 1981,95:414-420.
6. Veronesi A, et al. Am J Clin Oncol 1988,11:566-571.
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