Bone marrow transplantation
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Bone Marrow Transplant. · May 1999
Randomized Controlled Trial Comparative Study Clinical TrialBone marrow harvesting using EMLA (eutectic mixture of local anaesthetics) cream, local anaesthesia and patient-controlled analgesia with alfentanil.
Bone marrow harvesting (BMH) was performed on 40 consecutive allogeneic or autologous donors using EMLA (eutectic mixture of local anaesthetics), local anaesthesia (LA) and patient-controlled analgesia with alfentanil (PCA-A). The effect of alkalinizing the LA solution on reducing pain during LA infiltration in the presence of EMLA was also investigated. EMLA 10 g with occlusive dressing was applied to the harvest sites at least 60 min before BMH. ⋯ They completed BMH using either regimen successfully, found this technique acceptable and would recommend this form of anaesthesia to others. Alkalinizing the LA solution did not significantly improve the pain scores during LA infiltration in the presence of EMLA. In conclusion, BMH can be performed safely using EMLA, LA and PCA-A without major complications.
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Bone Marrow Transplant. · May 1999
Clinical TrialThiotepa, busulfan and cyclophosphamide as a preparative regimen for allogeneic transplantation for advanced chronic myelogenous leukemia.
Thirty-six adults with chronic myelogenous leukemia (CML) in second or greater chronic phase, accelerated phase, or blast crisis underwent marrow or blood stem cell transplantation from an HLA-matched sibling using high-dose thiotepa, busulfan and cyclophosphamide (TBC) as the preparative regimen. All evaluable patients engrafted and had complete donor chimerism. One patient failed to clear meningeal leukemia, and one patient had one of 30 metaphases positive for the Philadelphia chromosome at 2 months post transplant. ⋯ Three-year survival is 28% (95% CI, 13-43%). Survival was significantly higher for patients transplanted without blast crisis (45% vs 0%, P = 0.01). TBC is an effective preparative regimen for CML in accelerated phase but not refractory blast crisis, and it should be used with caution in patients with prior hepatopathy who have an increased risk of severe VOD.