B. Witt

Mobilization of Blood Stem Cells with Recombinant Human (rh)G-CSF in Patients with Hematological Malignancies and Solid Tumors

Peripheral blood stem cells (PBSC) are being increasingly used for autografting in patients with malignant diseases to circumvent the myelotoxic effects of high-dose therapy [1]. It is generally accepted that the kinetics of hematological recovery following autografting essentially depend on the number of hemopoietic stem cells transplanted [2, 3]. In the past, different methods have thus been explored to improve blood stem cell collection [4, 5].

High-dose Therapy and Autografting with Mobilized Peripheral Blood Progenitor Cells in Patients with Malignant Lymphoma

In this report we present the data of 100 patients who were autografted with peripheral blood progenitor cells (PBPC) following high-dose conditioning therapy. Fifty-six patients were male and 44 were female with a median age of 36 years (range 19–58). Thirty-five patients had Hodgkin’s disease and 65 non-Hodgkin lymphoma (NHL). PBPC were collected either following the administration of recombinant human GM-CSF or G-CSF during steady-state hematopoiesis or during cytokine-enhanced recovery after cytotoxic chemotherapy. Seven patients were autografted using PBPC harvested post-chemotherapy without cytokine support. At the time of PBPC mobilization 21 patients had bone marrow involvement by histopathological examination. The high-dose preparatory regimens were either BEAM (BCNU, etoposide, cytosine arabinoside, melphalan), CBV (cyclophosphamide, BCNU, etoposide), or a combination of total body irradiation (TBI) and cyclophosphamide. In 92 patients hematological reconstitution was evaluable. The median time to reach a neutrophil count ≥ 0.5 × 109/l was 14 days (range 9–69) and an unsubstituted platelet count > 20 × 109/l was observed after a median of 12 days (range 6–205). Seven patients died of transplant-related toxicity. Twenty-seven patients relapsed or had further tumor progression after a median time of 5 months (range 1–49) post-transplantation. With a median follow-up of 14 months (range 1–64), 66 patients are alive in unmaintained remission. There is no evidence for late graft failure. These data reflect the ability of blood-derived hematopoietic progenitor cells to restore long-term hematopoiesis after myeloablative therapy without additional bone marrow support.

Autologous Transplantation with Mafosfamide-Purged Bone Marrow for Acute Myelogenous Leukemia in First and Second Complete Remission

Despite improvements in the conventional treatment of adult patients with acute myelogenous leukemia (AML) the probability of Gontinuous CR ranges from 8% to 45% at 3 years [1]. Intensive consolidation therapy has a benefitial impact on the prognosis of younger patients [2]. Therefore, based on the experience with allogeneic BMT autologous transplantation has been introduced as high dose consolidation treatment in first or second remission [3,4]. Despite encouraging results the role of high-dose consolidation therapy and autografting for patients with AML has not been established on the basis of controlled randomized studies. It was the purpose of our retrospective analysis to evaluate prognostic factors influencing the clinical outcome following ABMT.

Autologous Bone Marrow Transplantation in Patients with Acute Lymphoblastic Leukemia in Second or Subsequent Complete Remission

With intensive conventional chemotherapy a complete remission (CR) can be achieved in more than 90% of children and 70% of adults with ALL [l].The long-term disease-free survival for patients with ALL depends on certain prognostic factors [2]. As it has been shown by several investigators, high-risk patients can be defined on the basis of initial white blood count, age, the immunological phenotype of blast cells, the time to achieve CR after the induction phase of chemotherapy and by the presence of a Philadelphia chromosome. With respect to the therapeutic benefit of bone marrow transplantation (BMT) in high-risk ALL, the data of the International Bone Marrow Transplant Registry demonstrate that for allogeneic BMT the 5-year probability of disease-free survival (DFS) is 50% in first complete remission (CR) versus 32% in second CR [3]. Kersey et al. [4] reported a series of patients with high-risk ALL who were transplanted either in first or second CR.These patients demonstrated an overall disease-free survival of 20% at 5 years post-BMT.