Summary:different from that measured in historical controls who received 600 mg/m 2 of BCNU. Combined hospital and physician charges for patients treated at the University Breast cancer patients with more than three involved axillary lymph have a high likelihood of relapse after of Colorado decreased from a mean of $125 845 for the first four patients to $77 126 for the final seven patients. adjuvant therapy. Early results of administration of high-dose chemotherapy (HDCT) and autologous periWe conclude that HDCT with autologous PBPC can be administered with acceptable safety to patients with pripheral blood progenitor cells (PBPC) to patients with primary breast cancer and у у у10 involved axillary nodes mary breast cancer involving 4-9 axillary lymph nodes. An ongoing, prospective randomized trial is evaluating have been encouraging. We performed a multicenter trial to determine whether HDCT could be safely the efficacy of HDCT for this patient group. Keywords: stem cell transplantation; dose-intensive administered to patients with primary breast cancer involving 4-9 axillary lymph nodes. Fifty-four patients therapy; breast cancer with stage II or III breast cancer and 4---9 involved axillary lymph nodes received doxorubicin-based induction chemotherapy, followed by high-dose cyclophosphamideThe prognosis of patients with primary breast cancer is (5.625 g/m 2 ), cisplatin (165 mg/m 2 ), and BCNU directly dependent upon the number of involved axillary (450 mg/m 2 ) and PBPC mobilized by sargramostim lymph nodes at the time of diagnosis. While adjuvant (GM-CSF) or filgrastim (G-CSF). After completion of chemotherapy or hormonal therapy have resulted in benefit HDCT, patients received radiation therapy to the chest for these patients, many still develop recurrent disease.1 wall or involved breast, plus tamoxifen. Survival and High-dose chemotherapy (HDCT) is being employed for disease-free survival, time to engraftment, and charges patients with metastatic breast cancer and for those with associated with HDCT were determined. Plasma conprimary breast cancer who are at great risk of relapse after centrations of BCNU were determined and plasma adjuvant therapy. 2-6 A prospective randomized trial demon-AUC BCNU was calculated. Fifty-four patients were evalustrated that HDCT was superior to standard-dose therapy able for survival and relapse-free survival. Fifty-two for patients with metastatic breast cancer. 7 Treatment for patients received HDCT with PBPC support and were primary breast cancer has been limited to patients with 10 evaluable for toxicity. Fifteen patients (29%) developed or more involved axillary nodes at diagnosis, the early late pulmonary drug toxicity, which resolved with a 10-results of which are extremely promising. 6 Two prospecweek course of corticosteroids in all but one affected tive, randomized trials are ongoing to determine whether patient, who subsequently died of pulmonary toxicity.HDCT is superior to conventional dose therapy for the у10 Ten patients relapsed a median of 426 days (rang...
Summary:A 15-year-old female received an unrelated three of six HLA antigen matched umbilical cord blood (UCB) transplant for refractory, relapsed T-cell ALL. Conditioning consisted of TBI, melphalan, and anti-thymocyte globulin (ATG), with cyclosporin A (CsA) and solumedrol for GVHD prophylaxis. She engrafted and a day 34 bone marrow aspirate showed 100% donor cells and no evidence of leukemia. The post-transplant course was complicated by mild grade I acute GVHD involving skin, and limited chronic GVHD of the gut which resolved with the addition of 1 mg/kg/day of steroids to her CsA prophylaxis. One hundred and ninety days after transplantation the patient developed pancytopenia and was subsequently found to have a leukemic relapse. Immunosuppression was discontinued and she was started on G-CSF and erythropoietin. Moderate skin and gut GVHD developed which was treated with both topical and low-dose oral steroids. Over the next few weeks she became transfusion independent and a follow-up bone marrow aspirate showed complete remission. She continued in complete remission for 4 months, at which time localized leukemic relapse was found in a soft tissue breast mass in spite of continued bone marrow remission. from BMT but lack a suitably matched conventional transplant donor.1-4 Preliminary results have suggested that UCB transplantation may be associated with a lower incidence of acute GVHD than unrelated bone marrow, and require less stringent HLA matching.2-4 While less GVHD is a potential benefit of UCB transplantation, there is concern that UCB may not be able to generate a sufficient GVL effect in patients with hematologic malignancies, resulting in increased relapse rates and limiting its practical utility. In this report we describe a patient who relapsed after undergoing UCB transplantation from a partially mismatched (3/6) unrelated donor for refractory relapsed T cell ALL. A complete remission was achieved following discontinuation of immunosuppression and institution of cytokine support. Whether UCB cells generate a GVL effect in all patients is unknown, but this case report clearly demonstrates that UCB has the potential to generate a GVL effect and this effect can be powerful enough to induce a complete remission. As the biology and mechanisms of GVHD and GVL are more completely understood, it may become possible to uncouple these two immune responses and maximize the benefits of hematopoietic stem cell transplantation without compromising anti-leukemic effects. Case reportA 15-year-old white female had been diagnosed with CD7 +
Congenital sideroblastic anemia (CSA) is a dyserythropoietic disorder that leads to transfusion dependency and subsequent iron overload. Nonmyeloablative allogeneic hematopoietic stem cell transplantation (NST) was performed for a patient with CSA, who had contraindications to conventional allografting. Conditioning was fludarabine, low-dose total body irradiation and antithymocyte globulin, followed by peripheral blood stem cell transplant. Cyclosporine and mycophenolate mofetil were used for graft-versus-host disease prophylaxis. Complete donor chimerism was observed day +131. Early after transplant, the patient became transfusion independent, allowing a regular phlebotomy program. On day +190, refractory lactic acidosis followed by fatal cardiovascular collapse developed, without evidence of infection. Data from this case demonstrates that NST may correct the erythropoietic defect of CSA.
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