Bone marrow transplantation
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Bone Marrow Transplant. · Jun 1996
A study of thiotepa, etoposide and fractionated total body irradiation as a preparative regimen prior to bone marrow transplantation for poor prognosis patients with neuroblastoma.
We report the toxicity and efficacy of a new conditioning regimen for bone marrow transplantation (BMT) in children with poor prognosis neuroblastoma (NBL). Twenty-seven patients with poor prognosis NBL were treated with teniposide (360 mg/m2) or etoposide (500 mg/m2), thiotepa (600-900 mg/m2), and 1200 cGy fractionated total body irradiation (fTBI) followed by autologous marrow rescue (n = 19) or allogeneic BMT from HLA-identical siblings (n = 8). The two patients who received teniposide, 600 mg/m2 thiotepa and fTBI had minimal toxicity but relapsed 4 and 12 months post-auto BMT. ⋯ Three allograft recipients have relapsed at 6, 10 and 39 months post-transplant and three are alive and in remission 75, 53 and 27 months post-BMT. Overall, 11/27 patients (41%) are alive and in remission 21-77 months (median 47 months) following BMT. A conditioning regimen consisting of 500 mg/m2 etoposide, thiotepa (750 mg/m2 for allograft recipients and 900 mg/m2 for autograft recipients) and 1200 cGy fTBI has acceptable toxicity and is at least as effective as melphalan-containing regimens in the treatment of high-risk NBL.
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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.