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

Lung complications were observed 22 times in 18 patients: 3 embolisms of
which 1 was fatal and 19 pneumonitis (18%). Fifteen occurred in the first two
months. Among these 15 patients, 9 had partial pneumonitis while 2 had interstitial
pneumonitis, life-threatening, requiring assisted ventilation (1 case fatal).
Four patients experienced diffuse with 1 requiring assisted ventilation and fatal
(surinfection with Pneumocystis carinii). in 4 patients, pneumonitis occurred
after 2 months in a context of tumor progression with neurologic degradation
and corticosteroid treatment.
Hepatic toxicity was mild. 20 % of patients had a minor cytolysis with grade
1 and 2 increase of AST-ALT. 70 % of patients had GGT increased before BCNU
probably due to the anticomital treatment and only 15% with normal GGT before
BCNU, experienced GGT increased after treatment. Two patients presented
with jaundice: 1 HBV hepatitis and 1 CMV.
Twenty-nine infectious episodes including pneumonitis and hepatitis already
described were observed: 19 (66 %) in the first two months after BCNU.
The others occurred later and are not related to the treatment program,
intricated with the disease progression. Other complications were observed:
phlebitis (n=6), toxidermia (n=4, in these patients, symptoms disappeared when
phenytoin anticomital treatment was discontinued). Renal function remained
normal except for 5 patients with a grade I toxicity.
Irradiation was performed as scheduled in 86 patients. The tolerance was
good and the classical cerebral edema, often present at the initiation of the treatment
could readily be controlled with appropriate medications. However, one
patient died of a cerebral hemorrhage 3 days after the end of radiotherapy, with
normal platelet count.
Finally, 32 critical events are recorded in the first month after ABMT and the
total toxic death rate is 9% (8 patients): 1 septic shock, 1 hemorrhage, 1
pneumonitis, 1 brain toxoplasmosis infection, 3 septicemias (1 Candida albicans,
1 staphylococcus, 1 unknown). One patient died from embolism that is not considered
as a complication of treatment but of the disease itself.
2.2 Survival
Survival is the major evaluation criteria in this study as tumor response
evaluation is difficult due to the surgical reduction before BCNU treatment.
The median follow-up of this study is now 44 months. Overall survival is
11% at 36 months with a median survival at 11 months after ABMT and 12
months after surgery for the whole group (103 patients). These results are comparable
to those previously published in the literature ( 3
" 5
).
Three prognostic factors were identified, histological grading, performance
status and age. The median survival of patients with grade in tumors is 18
months compared to 10 months for those with grade IV. At 3 years 36 % grade
III are surviving versus 4% for grade IV. Patients under 50 years with a good
performance status (0,1 or 2) have a median survival of 16 months versus 10
months for older patients or those with a poor PS, and versus 6 months for older
patients with a PS>2. Complete resection was performed in 39 % of patients and
was not associated with a better survival.
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 217