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

TOXICITY
Preparation Regimen
The preparative regimens were generally well-tolerated. Most patients experienced
mild to moderate nausea and vomiting during the administration of
chemotherapy and fTBI. Mucositis was moderate to severe. Diarrhea was experienced
by the majority of patients in the first two weeks after TBI. Almost all
patients became febrile during the period of marrow hypoplasia and leukopenia
and required multiple parenteral antibiotics including amphotericin B.
Eight patients died within two months of ABMT while in the recovery
phase. Six patients died from overwhelming sepsis despite aggressive antimicrobial
therapy, one from hemorrhagic complications due to refractoriness to platelet
transfusions, and one from pulmonary and hepatic failure.
Marrow Infusion
The infusion of bone marrow was well-tolerated. Patients were
premedicated with acetaminophen, diphenhydramine and hydrocortisone. Hydration
at 1.5 - 2 times maintenance was maintained for 24 hours with marrow
infusion. Blood pressure and cardiac monitoring were carried out during bone
marrow infusion.
Five patients required a second infusion of MAb-treated marrow when engraftment
appeared delayed. In each case, a moderately severe reaction occurred.
In one patient this was manifest as hypotension associated with syncope.
In the other patients, respiratory distress associated with pulmonary infiltrates
developed several hours after the infusion. Each patient was treated with aggressive
fluid and corticosteroid therapy, and all reactions were reversed without
sequellae. No patient required intubation and mechanical ventilation. In
each case engraftment followed the infusion of the treated "back-up" bone marrow.
None of the patients with prolonged thrombopenia received "back-up"
marrow.
CFUS
The effect of the MAb and C treatment on CFUS was determined by culture
of cells in methylcellulose. The median recovery of CFU-GM progenitor cells
was 38% (range 22-150) for the first CR group, 48% (range 1-190) for the second/
third CR group and 87% (range 58-248) for the relapse group. Median recovery
of BFU-E was 49% (range 29-136) for the first CR group, 69% (range 1-2500) for
the second/third CR group and 100% (range 0-392) for the relapse group. Median
recovery of CFU-MIX was 50% (range 17-60) for the first CR group, 37%
(range 0-381) for the second/third CR group and 13% (range 0-249) for the relapse
group.
Engraftment
A median number of 4.0 x 10 7
cells/kg body weight (range 2.30 x 10 7
to 8.23
x 10 7
) were infused into each first CR patient. The median number of cells transfused
into the second/third CR group was 2.80 x 107 (range 7.50 x 10 6
to 1.16 x
10 s
). A median number of 4.10 x 10 7
cells/kg body weight (range 2.38 x 10 7
to
5.96 x 10 8
) were infused into each first relapse patient.
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 23