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

1.2 Description of the study
The treatment plan was the following:
- Cyto-reductive surgery as wide as possible on day 0.
- Bone marrow harvest on d21:l x 108 mononuclear cells/kg were harvested.
A buffy coat was performed to reduce the volume to 100-150 ml. The
marrow was then stored at 4° C.
- On the afternoon of marrow harvest, high dose BCNU (800 mg/ m2) was
administered over a 2-hour infusion.
- The patient was discharged from the hospital on the following day.
- Monitoring was organized on an out-patient basis with one weekly blood
count, hepatic and renal biology, physical staging and chest X-ray.
- Radiation therapy was scheduled approximately on day 45. The total delivered
dose was 45 Gy in 19 days, using the 18 MV energy of a linear accelerator:
24 Gy in 8 fractions to the whole subtentorial brain, followed by a localized
boost of 21 Gy in 7 fractions to the tumor or tumor bed. Every radiotherapy field
was designed using the dosimetry CT scan planning system.
- Overall survival was chosen as the main evaluation criteria.
- The first 16 treated patients also received an early post-operative chemotherapy
given on day 3 after histology confirmation, combining. VM 26,150
mg/m 2
, BCNU, 100 mg/m 2
in a 5 mn IV short infusion, through a peripheral
venous access. PROCARBAZINE (day 3 to 10), 100 mg/m2/day, per os. This
part of the chemotherapy program was deleted in March 1987 after the 16 first
patients because of the difficulty of feasibility.
2. Results
2.1 Evaluation of the toxicity
The toxicity observed in the 103 patients is similar to the first observations
we presented and much lower in the most recently treated patients.
2.1.1 Bone marrow harvest
Following general anesthesia for bone marrow harvest, 3 of the first patients
experienced a decrease of consciousness and enhancement of neurologic impairment
or cranial hyperpressure which was suspected to be related to hydration
administered during general anesthesia. The next patients received furosemide
at the end of anesthesia and did not experienced these symptoms.
2.1.2 Hematological toxicity
Hematologic toxicity remained mild: 9 % of the patients experienced a grade
4 aplasia for neutrophil (PMNN) and 6% for WBC. Grade 3 toxicity was observed
in 16% of the patients for PMNN and in 21% for WBC. Thrombopenia
grade 4 was observed in 10% of patients, grade 3 in 18% and grade 0,1 or 2 in 72
%. For patients with grade 3 or 4, the mean duration of thrombopenia is 10 days.
Nadir for WBC, neutrophils is on the second week while nadir for platelets on
the third week.
2.1.3 Extrahematological toxicity
Immediate tolerance of BCNU was good. Nausea and vomiting were mild:
31 grade 0,58 grade 1 and 2,9 grade 3.
226 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION