Bone marrow transplantation
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Bone Marrow Transplant. · May 1996
Multicenter Study Comparative Study Clinical TrialComparative analysis of two consecutive phase II studies with IFN-alpha and IFN-alpha + ara-C in untreated chronic-phase CML patients. Austrian CML Study Group.
Two consecutive phase II studies with IFN-alpha (n = 55) and with IFN-alpha/ara-C (n = 84) are compared in a retrospective analysis of untreated chronic-phase CML patients. Hematological responses (CHR and PHR) were seen in 76% of patients after IFN-alpha and in 77% after IFN-alpha/ara-C treatment with a higher CHR rate in the latter group (45% versus 54%). Moreover, cytogenetic responses were observed more frequently in the IFN-alpha/ara-C study (44% versus 34%), including a higher rate of complete cytogenetic responses (13% versus 9%). The combined treatment modality induced higher rates of hematotoxicity (e.g. thrombocytopenia: 44% versus 25%) and gastrointestinal side effects (38% versus 15%) as compared to the monotherapy study.
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Bone Marrow Transplant. · May 1996
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialLow-dose interferon-alpha 2b combined with hydroxyurea versus hydroxyurea alone for chronic myelogenous leukemia.
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Bone Marrow Transplant. · May 1996
Clinical TrialHigh response rate using recombinant interferon-alpha in patients with newly diagnosed chronic myeloid leukemia.
To improve the management of chronic myeloid leukemia (CML) in a single center, we have used interferon-alpha (IFN-alpha) to treat newly diagnosed Ph-positive CML patients and investigated the factors predictive of a major cytogenetic response. Eighty-one patients with a median age of 50.5 y (17-70) were given IFN-alpha (5 x 10(6)/sqm/day, s.c.). The median interval between diagnosis and IFN-alpha was 45 days (0-160). ⋯ Moreover, we found that the MCR or CCR were significantly influenced by the obtaining of CHR at three months (p < 0.001 and p < 0.0001, respectively). These results show that IFN-alpha can induce high rates of hematological and cytogenetic responses when administered in doses leading to myelosuppression. The achievement of CHR within three months could be useful to identify early those patients who will not respond to IFN-alpha and who need alternative treatments such as allogeneic or autologous stem cell transplantation.
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Bone Marrow Transplant. · May 1996
Unrelated allogeneic bone marrow transplantation using high-dose busulfan and cyclophosphamide (BU-CY) for the preparative regimen.
This study reviews results of a radiation-free preparative regimen consisting of busulfan and cyclophosphamide in 65 unrelated allogeneic bone marrow transplant recipients. Thirty-eight patients had chronic myelogenous leukemia (17 patients chronic phase, 13 patients accelerated phase, eight patients blast phase), 19 patients had acute leukemia (second complete remission or relapse) and eight patients had myelodysplasia. The patients were transplanted at four different medical centers from July 1988 to November 1992. ⋯ The most common causes of death were graft-versus-host disease (37%), and transplant-related toxicity (59%); relapse (4%) was a rare cause of death. Busulfan/cyclophosphamide is an effective preparative regimen in unrelated bone marrow transplantation permitting adequate engraftment and a low relapse rate. Best results are observed in patients less than 20 years old.
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Bone Marrow Transplant. · May 1996
Campath-1G in vivo confers a low incidence of graft-versus-host disease associated with a high incidence of mixed chimaerism after bone marrow transplantation for severe aplastic anaemia using HLA-identical sibling donors.
We have evaluated the effect of in vivo Campath-1G on engraftment and GVHD in 23 patients with severe aplastic anaemia transplanted from HLA-identical sibling donors. In 14 patients Campath 1g was given pre-transplant for up to 9 days in an attempt to overcome graft rejection (group 1). In nine patients Campath-1G was given pre-transplant, but also continued post-transplant until day +5 to reduce GVHD (group 2). ⋯ Of 11 patients with initial neutrophil engraftment, only one had 100% donor haemopoiesis at all times. The remaining patients had either transient mixed chimaerism or persistence of recipient (< 20%) cells. We conclude that in vivo Campath-1G is associated with a high incidence of mixed chimaerism which tips the balance away from GVHD but towards graft rejection.