Substantial variation exists in access to BMT for patients with either leukemia or lymphoma. Black patients, those enrolled in HMOs, those covered by Medicaid, and self-pay patients were less likely to receive a BMT when admitted for either leukemia or lymphoma. These findings raise concerns about access to cancer treatments for patients in the current health care system.

Summary:We previously demonstrated findings suggestive of autologous GVHD in patients receiving IL-2-activated peripheral blood stem cells (PBSC) with IL-2 after transplantation. A pilot study was designed to test tolerability, feasibility and frequency of autologous GVHD and engraftment using IL-2 and ␣-IFN posttransplantation. After cyclophosphamide (6 g/m 2 ) and carboplatin (1800 mg/m 2 ), patients with high-risk stage II or III breast cancer received chemotherapy and rhG-CSF mobilized autologous PBSC that had been cultured in IL-2 for 24 h. Subcutaneous administration of IL-2 began on day 0 at 6 × 10 5 IU/m 2 /day for 5 of 7 days each week and continued for 4 weeks. Once engraftment occurred, ␣-IFN was initiated at a dose of 1 × 10 6 /m 2 /day subcutaneously for 30 days. Thirty-four consecutive patients with stage II (n = 20), IIIA (n = 6) and IIIB (n = 8) disease were treated. All patients were without evidence of disease at the time of transplantation. The average time required for the ANC to reach 500/mm 3 was 10 days (range: 8-11 days) and for platelets to reach 20 000/mm 3 was 10.7 days (range: 6-21 days). Forty-seven percent of patients (n = 16) completed the full course of immunotherapy; the remaining patients received attenuated doses due to patient's request (n = 6), development of temperature Ͼ38؇C (n = 3), development of neutropenia (n = 3), serious infection (n = 1) and miscellaneous reasons (n = 5). Four patients experienced transient moderate toxicities (level 3) including elevated liver function tests, nausea, rash and capillary leak syndrome. Pathological findings suggestive of skin GVHD developed in 43% of patients (12/28 patients) when skin biopsies were evaluated in a blinded fashion. At 13 months post-transplant (median; range: 5-24 months), 28 patients (82%) remain diseasefree. These results demonstrate the feasibility and toxicity of this regimen along with pathological findings compatible with autologous GVHD of the skin. Keywords: interleukin-2; ␣-interferon; breast cancer; stem cell transplantation; immunotherapy Hematopoietic stem cell (HSC) transplantation may improve disease-free survival for selected women with stage II-IV breast cancer. 1-3 Any attempt to further improve therapeutic efficacy by increasing chemotherapy dose may result in excessive nonhematologic toxicities. Immunomodulation, in conjunction with high-dose chemotherapy and HSC transplantation may offer a potential benefit by providing a non-cross-resistant mechanism of tumor cell kill with non-overlapping toxicities. In addition, immunotherapy following autologous HSC transplantation has been associated with the development of graft-versushost disease (GVHD). [4][5][6] The generation of autologous GVHD in patients undergoing autologous HSC transplantation using immunomodulation, has been described in patients with breast cancer, multiple myeloma, lymphoma and acute myelogenous leukemia. [7][8][9][10][11][12] In the allogeneic BMT setting, the existence of GVHD is presumed to be associated with a graft-versus-tumor...

Long-term survival following chemotherapy or autologous bone marrow transplantation in adults with relapsed/refractory non-Hodgkin's lymphoma was evaluated. English language articles published from January 1, 1988 to September 1, 1993 were obtained from a broad-based MEDLINE search retrieving 3,854 citations regarding therapy for lymphomas. Citations were evaluated using both computer-based evaluation and manual review. Articles were included if they addressed the disease of interest (non-Hodgkin's lymphoma, Working Formulation D-H), the population of interest (adults with either relapsed or refractory disease), and the therapies of interest (chemotherapy or autologous bone marrow transplantation). Articles were excluded if they did not provide convincing information on long-term survival (as evidenced by either survival analysis or individual patient data) or if they reported a small number of patients (N < 15). No randomized trials of the two therapies were found. Nine case series were found reporting on 444 eligible patients receiving chemotherapy; eight were found reporting on 256 patients undergoing autologous marrow transplantation. After weighting by sample size, the mean 3-year survival rate was 25% (95% CI, 20-30%) following chemotherapy and 40% (95% CI, 33-47%) following marrow transplantation. The reporting of potentially relevant prognostic factors was inconsistent among articles. Despite our comprehensive synthesis and evaluation of currently available data, the survival advantage of marrow transplantation in relapsed/refractory non-Hodgkin's lymphoma that we report must be viewed as tentative, given the limitations of the case series data. In addition, establishing the comparability of patients treated with these therapies is made more difficult by the inconsistent reporting of potentially relevant prognostic factors. The results of an international randomized trial of these two therapies is forthcoming and may address some of these shortcomings.

Summary:To determine the outcomes of women with isolated locoregional recurrence (LRR) of breast cancer treated with high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) following conventional therapy, we conducted a retrospective review of 58 patients from five institutions treated between 1990 and 1998. Forty-five patients (78%) had у2 poor prognostic factors (