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

Busulfan (4mg/kg/day 4 days) and high dose Melphalan (HDM) (140 mg/
m 2
,1 day). Three months later, these patients underwent a second transplant
with HDM alone as preparative regimen. Once hematopoietic reconstitution
was observed after the second transplant (WBC count more than 5 x 10V1 and
platelets more than 100 x 10 9
/1), subcutaneous IFN was given at a dose of 5 x 10 6
U/day/three times a week.
CML in chronic phase (Group II)
Twenty-two patients (median age: 44 years; 22-54) were transplanted in
chronic phase. The reasons for ABSCT were either the presence of high risk
prognostic factors according to Sokal's classification (n=15) or no response to
IFN (n=7). This group underwent a single transplant after Busulfan and HDM as
described above. Secondarily, the patients received IFN according to the same
schedule as the patients transplanted in transformation.
Cytogenetic studies on at least 20 metaphases, were performed every three
months. The cytogenetic response was classified as minimal, minor, partial or
complete, according to criteria defined by TalpazIn patients achieving complete
cytogenetic response, molecular studies were performed.
RESULTS
Group I
No patient died from transplant-related complications and a second chronic
phase was achieved in all cases. Only 17 of the 24 patients received the second
transplant. Seven patients did not undergo the second transplant for the following
reasons: three patients had a recurrent transformation phase after the first
transplant (median 2.5 months), two patients refused the second transplant, one
patient suffered from veno-occlusive disease and one patient had a prolonged
fever of unspecified origin. All the 17 patients who underwent the second transplant
received IFN. This treatment was well tolerated and the doses were adjusted
in accordance to hematological and cytogenetic response.
Twenty three of the 24 patients achieved a complete hematological response
(CHR). Seven of the 20 évaluable patients achieved a cytogenetic response (complete
- 1, partial = 2, minor = 4). Fifteen patients had recurrent transformation 3
to 23 months after ABSCT. Two patients died without transformation from infection.
Seven patients are still alive in chronic phase or CHR 3 to 73 months after
ABSCT. The complete cytogenetic response observed in the one patient occurred
12 months after the initiation of IFN and is still complete 48 months later.
The PCR analysis of blood samples from this patient after four years of IFN, are
negative