1. Mucositis is a common side-effect of chemotherapy which is difficult to assess except by invasive means such as upper gastrointestinal endoscopy. Differential absorption of mono- and di-saccharides, such as rhamnose and lactulose, is a non-invasive measure of intestinal damage. 2. The purpose of the study was to assess the duration and severity of intestinal damage in patients undergoing high-dose chemotherapy and autologous blood stem-cell transplantation for malignant disease. 3. Thirty-five patients were studied before treatment and at 7, 28, 60 and 90 days after treatment. 4. The median lactulose/rhamnose ratios before treatment and at 7 and 90 days post-treatment were 0.09, 0.62 and 0.06 respectively. Altered permeability was due to both increased lactulose permeation and decreased rhamnose absorption. These abnormalities suggest a defect in tight-junction integrity as well as a decrease in surface area of small bowel. 5. We conclude that chemotherapy given for malignant disease is associated with a transient abnormality in intestinal sugar permeability, which peaks at 7 days after treatment and is composed of both mono- and di-saccharide absorption abnormalities.

AbetractSixty patients with malignancy were enrolled in a study of high dose chemotherapy and peripheral blood stem cell transplantation (PBSW. Stem cells were haxvested prior to PBSCT using 75 cycles of high-dose Cyclophosphamide (Cy) mobilization (4 or 7 G/m2) with collection of a median of 4.6 x lo8/@ mononuclear cells (MNC) (range 0.2 -9.5) and 21.6 x 104/kg colony forming unitgranulocyte /macrophage (CFU-CM) (range 0.1 -220). Forty seven patients were mobilized once, 1 1 required 2 cycles and 2 required 3 cycles. Eight patients (13%) fafled to reach the optimim CFU-GM target (total of > 15 x lo4 CFU-CM/kg) following Cy mobilization. In a multivariate regression analysis. a number of factors identified those patients who were likely to achieve optimum stem cell collections. These included the use of the higher Cy mobilization dose (P

The results show that the reappearance or persistence of marker-positive cells after autologous PBSCT is strongly associated with relapse.

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Summary. Mobilization of Philadelphia chromosome (Ph) negative blood progenitors was attempted in 23 newly diagnosed chronic myeloid leukaemia (CML) patients using a regimen of cyclophosphamide (CY) 5 g/m 2 and rHUG-CSF 150 mg/m 2 daily. This regimen was well tolerated with no major adverse events reported. More than 2 × 10 6 /kg CD34 þ cells were collected in 21 patients (91%). Predominantly Ph-negative mobilization (0-25% Ph-positive) was seen in 30% of cases overall and was confined to patients with a Sokal prognostic score < 1 (7/11 with Sokal score <1; 0/12 with Sokal score у1). Within the low Sokal index group, a low WBC count pre-mobilization and a low WBC nadir both correlated strongly with Ph-negative mobilization (P ¼ 0 . 006 and 0 . 02 respectively). Five of 19 patients receiving at least 6 months of Roferon A therapy post mobilization achieved a major cytogenetic response; all five patients were Ph-negative mobilizers. Therefore CML patients can be divided into a good-prognosis group in whom predominantly Ph-negative progenitors can be mobilized using a regimen of moderate intensity if haematological control is achieved pre-mobilization, and a poorprognosis group for whom predominantly Ph-positive cells are mobilized with this regimen regardless of haematological control.