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

(range 15-55); 68 males and 32 females. At diagnosis, 11 patients were in stage II
(bulky > 10 cm.), 14 in stage III, and 75 in stage IV. Other characteristics present
at diagnosis are described in Table 1.
Histologic subtypes according to the Kiel Classification and the Working
Formulation, and the status at ABMT are reported in Table 2. Performance status
at transplant was 0-2(ECOG). All patients had received at least one regimen
containing Doxorubicin (CHOP, ProMACE-MOPP, MACOP-B). The Lymphoblastic
Lymphoma had been pretreated with a sequential chemotherapy (31)
.
Forty-five patients underwent ABMT in 1st CR. Twenty patients (Groups F-
G-H-J/WF) fulfilled the following criteria for ABMT procedure: 1) diffuse, intermediate
or high-grade malignancy NHL, in advanced stage at diagnosis (II
bulky > 10 cm, III or IV); 2) two or more negative prognostic factors at diagnosis:
CR > 3 courses, LDH >500 IU/L, bone marrow involvement, bulky disease >10
cm (for stage III and IV), B symptoms, two or more extranodal localizations.
Lymphoblastic lymphoma in 1st CR (25 patients) was admitted in stage II bulky,
III and IV stage, with an age > 15 years, with less than 25% of blasts in bone marrow
and less than 10% of circulating blasts.
No additional negative factors were required in 2nd CR (16 patients) and in
1st partial response (PR 1) (21 patients).
The last group of 18 patients included, 6 refractory to front-line therapy, 5
relapsed and directly admitted to ABMT (untreated relapse), and 7 relapsed and
responding to a second-line therapy (sensitive relapse).
In the 35 patients who presented with partially infiltrated marrow at diagnosis,
the harvested marrows were purged with a dose of mafosfamide (ASTA
Z 7557) able to spare 5% of normal CFU-GM, as reported by Gorin et al (33)
. In
our cases, a median dose of 90 mcg/2 x 10 7
cells was used (range 50-100). The
marrows were cryopreserved and stored in the vapour phase of a liquid nitrogen
freezer.
The conditioning regimens and the number of patients were as follows: 1)
Cytoxan plus Total Body Irradiation (10 Gy in a single dose) - 74 patients; BEAM
regimen -13 patients; BE AC regimen - 5 patients; BU-CY regimen - 5 patients;
CVB regimen - 3 patients.
In all cases, the harvested marrows were reinfused at day 0. The patients
were adequately hydrated and received Mesna, Allopurinol, Furosemide and
anti-emetic drugs. They also received parenteral hyperalimentation. Platelet
transfusions from individual donors were given for platelet counts under 20 x
10 9
/1. Leucocyte-free erythrocyte concentrates were administered when hemoglobin
values fell below 10 gr/dl. All allogeneic cells were irradiated. Patient's
response was evaluated one month after ABMT, and a complete restaging after
three months. Continuous complete remission (CCR) was defined as CR maintenance
after transplantation. Complete remission (CR) refers to the complete disappearance
of the tumor after therapy. The incidence and severity of adverse
events were recorded and graded according to WHO criteria. Overall survival
and overall DFS were estimated by the Kaplan and Meyer method and compared
by log-rank test. The stastical analysis was performed in September 1992.
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SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION