Bone marrow transplantation
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Bone Marrow Transplant. · Feb 1996
Comparative Study Clinical TrialHigh-dose therapy with peripheral blood progenitor cell transplantation in low-grade non-Hodgkin's lymphoma.
It was the objective of our study to evaluate the efficacy of a sequential high-dose therapy with peripheral blood progenitor cell (PBPC) support in patients with low-grade non-Hodgkin's lymphoma (NHL). Since July 1991, 48 patients (23 male/25 female) with a median age of 43 years (range 26-55) were included in the study. At the time of entry, 28 patients were in first and seven in second or higher remission. ⋯ Thirty-nine patients are alive in remission after a median follow-up time of 15 months (range 1-31), while seven patients relapsed between 5 and 29 months post-transplantation. Except for one patient autografted in first remission, the patients with relapse had a history of previous relapse or progressive disease. Since the probability of disease-free survival appears to be related to the disease status at the time of autografting, PBPC-supported high-dose therapy including total body irradiation should be investigated further for patients with low-grade NHL while they are in first remission.
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Bone Marrow Transplant. · Feb 1996
Hematopoietic precursor cell transplants in Europe: activity in 1994. Report from the European Group for Blood and Marrow Transplantation (EBMT).
This report, the fifth of a series, summarizes indications and donor source of hematopoietic precursor cell transplants performed in Europe in 1994 and illustrates the evolution since 1990. 306 teams in 30 participating countries performed a total of 10 066 transplants, 3502 allogeneic and 6564 autologous transplants. In 1990, there were only 143 teams and a total of 4234 transplants, 2137 allogeneic and 2097 autologous transplants. Main indications in 1994 were leukemias with 3881 transplants (39%), 2635 allogeneic (75%) and 1246 autologous (19%) transplants; lymphomas with 3760 transplants (37%), 245 allogeneic (7%) and 3515 autologous (54%) transplants; severe aplastic anemia with 250 transplants (2%), 248 allogeneic (7%) and 2 autologous transplants; solid tumors with 1800 transplants (18%), 13 allogeneic and 1787 autologous (27%) transplants and congenital disorders with 375 (4%) transplants, 361 allogeneic (11%) and 14 autologous transplants. ⋯ Donor source was bone marrow for 3322 allogeneic (95%) and 1869 autologous (29%) transplants, peripheral blood for 180 allogeneic (5%) and 4289 autologous (65%) transplants and a combination of bone marrow and peripheral blood for a few allogeneic and 406 autologous (6%) transplants. The relative proportion of peripheral blood as a source for autologous transplants has changed since 1991 from 15 to 72.1% in 1994. A similar trend for allogeneic transplants is just emerging.
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Bone Marrow Transplant. · Jan 1996
Results of allogeneic bone marrow transplantation for acute leukemia have improved in Europe with time--a report of the acute leukemia working party of the European group for blood and marrow transplantation (EBMT).
To evaluate whether the results of bone marrow transplantation have improved in Europe with time, we analyzed the outcome for 2195 patients with acute leukemia. 1405 had acute myeloid leukemia (AML) and 790 had acute lymphoblastic leukemia (ALL), and were allografted in first complete remission between September 1979 and December 1991 with marrow from an HLA-identical sibling donor. We found a continuing improvement more evident since 1987 for AML and since 1986 for ALL. A substantial reduction in the 3 years transplant related mortality (TRM): 26 vs 39% for AML (P = 10(-4)), and 25 vs 39% for ALL (P = 10(-4)), has resulted in an increase of the 5-year actuarial leukemia-free survival (LFS). 57 vs 45% for AML (P < 10(-4)) and 54 vs 45% (P = 10(-4)) for ALL. ⋯ The LFS was better after 1986 (P = 0.0004) and in younger patients (P = 10(-4)). However a better outcome after 1986/87 was observed in patients receiving the same GVHD prophylaxis: therefore, other unidentified factors resulting in better patient care have also contributed to this. The improved results of allogeneic BMT are entirely related to a reduction in TRM without loss of the antileukemic effect since relapse incidence has not changed over the years.
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Bone Marrow Transplant. · Nov 1995
Clinical TrialA phase I trial of interleukin 3 (IL-3) pre-bone marrow harvest with granulocyte-macrophage colony-stimulating factor (GM-CSF) post-stem cell infusion in patients with solid tumors receiving high-dose combination chemotherapy.
In humans, interleukin 3 (IL-3) administration increases the cellularity and cycling of bone marrow progenitor cell populations. Initially, in primates and then in humans, IL-3 in sequence with GM-CSF has been shown to stimulate multilineage hematopoiesis. Based upon these effects, we designed a phase I trial of daily IL-3 administered subcutaneously for 10 days at dose levels of 2.5, 5.0, 10.0, 12.5, and 15.0 micrograms/kg followed within 72 h by bone marrow harvest, high-dose chemotherapy, and following chemotherapy, a fixed dose (5.0 micrograms/kg/day) of GM-CSF and bone marrow rescue. ⋯ When IL-3 dose levels were analyzed separately, engraftment of neutrophils and platelets, blood product (platelets and packed RBCs) utilization, and discharge date were not superior in those treated with the higher dose (15.0 micrograms/kg) of IL-3. While higher doses of IL-3 were associated with more toxicity, they did not appear to enhance the stem cell pool or speed engraftment later. The effects of pre-bone marrow harvest IL-3 are modest and likely not as impressive as other approaches aimed at enhancing hematologic recovery following high-dose chemotherapy.
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Patients undergoing a bone marrow harvest have traditionally been hospitalized for several days. Recently, the feasibility of outpatient bone marrow harvesting has been reported. We retrospectively examined the results of 485 patients undergoing an outpatient bone marrow harvest from 1989 to 1993. ⋯ After adjusting for volume harvested and time under anesthesia, harvest yield was higher in normal donors and patients with breast cancer than for patients with non-Hodgkin's lymphoma and Hodgkin's disease. We conclude that outpatient harvesting is safe. The negative correlation of time under anesthesia with harvest yield may be a result of variables which are difficult to quantify, such as bone marrow microenvironment.