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

ized in table 1. There were 21 males and 21 females with a median age 38 years
(range 26-61 years). At diagnosis and at ABMT, ten patients had follicular small
cleaved, 30 follicular mixed and 2 follicular large cell lymphoma.
For each patient, staging including physical examination, thoracoabdominal
CT scan and trephine biopsy was performed at diagnosis, at relapse, and after
transplant at 3,6,12 months and subsequently every 12 months. Bone marrow
involvement was detected only by trephine biopsy examination. Prognostic
factors were determined at diagnosis: Ann Arbor stage, constitutional B-symptoms,
bulky disease defined as peripheral lymph nodes > 5 cm or abdominal
mass > 10 cm and number of extra nodal sites involved. All patients had previously
received poly chemotherapy. At the time of ABMT, 13 patients were in first
partial remission (PR1) and 29 in chemosensitive relapse (second complete remission
(CR2) = 16, PR2 = 5; CR3 = 4; PR3 = 4).
Preparative therapy was a combined chemotherapy in 22 patients and a TBI
containing regimen in 20 patients. Chemotherapy regimens were BEAM in 17
patients (carmustine 300 mg/m 2
on day 1, cytosine arabinoside 200 mg/ m 2
/ day
on days 2 to 5, etoposide 200 mg/m 2
/day on days 2 to 5 and melphalan 140
mg/m 2
on day 6), BEAC (cyclophosphamide 35 mg/kg/day on days 2 to 5 instead
of melphalan)in one patient, CBV (BCNU 300 mg/m 2
on day 1, cyclophosphamide
35 mg/kg/day on days 2 to 5 and etoposide 200 mg/m 2
/day on days
2 to 5) in 3 patients and TACC (CCNU 200 mg/m 2
on day 1, cytosine arabinoside
200 mg/m 2
/day and 6-thioguanine 200 mg/m 2
/day on days 2 to 5, cyclophosphamide
45 mg/kg/day on days 2 to 5) in one patient. Among these patients,
8 received radiotherapy in nodal involved sites after ABMT. Twenty patients
were conditioned with TBI and cyclophosphamide (60 mg/kg/day) for
two days; four patients received additive drugs: VP 16 (one patient), VP 16 and
ARA C (two patients), BCNU and VP 16 (one patient).
COLLECTION, PROCESSING AND INFUSION OF HEMATOPOIETIC STEM CELLS
Thirty seven patients were grafted with marrow hematopoietic stem cells. In
some institutions, if marrow involvement was documented at diagnosis or at
relapse, bone marrow purging was performed. Two techniques were used:
chemical purging with adapted doses of Asta Z (10 cases) and immunological
purging with two pan B monoclonal antibodies (5 cases). No assessment of bone
marrow purging efficiency was performed after purging. Five patients received
peripheral blood stem cells.
Peripheral Blood Stem Cell (PBSC) collection
In all patients PBSC were collected with a Haemonetics Model V50
apheresis device (Haemonetics, Braintree, MA). Stem cells were collected during
the recovery phase following aplasia induced by a conventional chemotherapy.
PBSC were collected using the lymphosurge program of the Haemonetics
V50 blood cell processor. Three or four cytapheresis were performed after each
course of chemotherapy, as soon as leukocyte count had reached 1 x 10V1-
Chemical Purging (n)
Two weeks before harvesting an individual pre-test was performed to determine
the dose of ASTA Z corresponding to 95 % destruction of CFU-GM
(LD95). Purging was performed after adjustment to 20 x 1 (^nuclear cells par ml
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 63