Infectious bronchitis virus, otherwise known as coronavirus, can cause mild upper respiratory tract illnesses in children and adults. Rarely has coronavirus been linked, either by serology or nasal wash, to pneumonia. We report a case of a young woman who, following treatment for stage IIIA breast cancer using a high-dose chemotherapy regimen followed by autologous bone marrow and stem cell transplantation, developed respiratory failure and was found to have coronavirus pneumonia as diagnosed by electron microscopy from BAL fluid. We propose that coronavirus should be considered in the differential diagnosis of acute respiratory failure in cancer patients who have undergone high-dose chemotherapy and autologous hematopoietic support.

The chance for long-term remission with induction therapy with AFM and high-dose chemotherapy is increased for hormone receptor positive-patients with nonvisceral metastases who have not received prior adjuvant chemotherapy and have long disease-free intervals.

The purpose of the present study was to determine the maximally tolerated dose of thioTEPA given with fixed high-dose cyclophosphamide (CPA) and cisplatin (cDDP) followed by autologous bone marrow (ABM) with or without granulocyte colony-stimulating factor (G-CSF)-primed peripheral-blood progenitor cells (PBPCs) in patients with advanced malignancies. Patients were required to have histologically documented malignancies and adequate renal, hepatic, pulmonary, and cardiac function. CPA was given at 1,875 mg/m2 per day as a 1-h i.v. infusion for 3 consecutive days, and cDDP was given at 55 mg/m2 per day as a 24-h continuous i.v infusion over 3 days concurrently with CPA. ThioTEPA was given once as a 1-h i.v. infusion (300-900 mg/m2) either following (the first 13 patients) or prior to CPA and cDDP. In all, 31 patients received PBPCs. A total of 46 patients were treated. There were 6 deaths among the 15 patients who did not receive PBPCs (13 received thioTEPA following CPA and cDDP). Among the other 31 patients who received PBPCs (all of whom also received thioTEPA prior to CPA and cDDP), there were 4 deaths, all involving patients with refractory ovarian carcinoma. The main toxicities were mucositis, esophagitis, hepatotoxicity, and nephrotoxicity. The median time required to achieve an absolute neutrophil count of 500 microliter was 10 days (range, 9-12 days) for those who received PBPCs and 15 days (range, 15-34 days) for those who did not receive PBPCs. Altogether, 47% of the major organ toxicities (grades 3 and 4 renal, hepatic, and cardiac toxicities) occurred among the 15 patients who did not receive PBPCs, although these patients received thioTEPA at the lowest 2 dose levels. There were 3 complete responses and 22 partial responses among 35 evaluable patients (overall response rate, 71%), with the median duration of response being 3.5 months (range, 2-17 months). The maximally tolerated dose of thioTEPA was 600 mg/m2 given as a 1-h i.v. infusion on the day prior to CPA and cDDP administration, The combination of high-dose CPA, cDDP, and thioTEPA is a well-tolerated regimen when thioTEPA is given prior to CPA and cDDP and when the combination also includes PBPCs in addition to ABM. This regimen is active in a variety of malignancies.

Summary:results and to the marked reduction in toxic mortality associated with this procedure. Over the past decade, there have also been significant Clinical trials involving breast cancer in the Duke University Bone Marrow Transplant Program were evaluimprovements in supportive care for patients undergoing high-dose chemotherapy, including better transfusion supated to assess the association between type of hematopoietic support and treatment-related morbidity/ port and treatment of infections. However, the most substantive improvements have been in hematopoietic support. mortality. Case histories of patients treated with highdose chemotherapy and hematopoietic rescue on threeThe use of hematopoietic growth factors and mobilized peripheral blood progenitor cells have dramatically reduced separate protocols between 1986 and 1994 were reviewed. This included 307 patients with stage IV disthe number of hospital days required for recovery from myeloablative therapy. 5-7 A marked reduction in mortality ease and 85 patients with high-risk (10 or more positive axillary lymph nodes) stage II or III disease. One hunhas also been found during this time period. A retrospective review of patients with breast cancer dred and twenty-eight of these patients were rescued with autologous bone marrow (BM) alone and 264 treated by the Duke University Bone Marrow Transplant Program was undertaken in order to analyze the additionally received autologous peripheral blood progenitor cells (PBPC). The 100 day transplant-related reasons for this improvement. Case records of several hundred patients who underwent high-dose chemotherapy with mortality rate in those patients who received BM alone was 20.3%, with an overall mortality rate due to the hematopoietic support over 8 years were reviewed. This included 307 patients with stage IV disease and 85 patients high-dose chemotherapy procedure of 24.2%. The PBPC-treated group experienced a 100 day transplantwith high-risk stage II or III disease. Of these patients, 128 received bone marrow alone and 264 received BM with the related mortality of only 6.1% and an overall transplant-related mortality of 10.2%. Sixteen of 31 deaths addition of mobilized peripheral blood progenitor cells for support. The overall treatment-related mortality and the were attributed to veno-occlusive disease (VOD) in the group that received BM alone compared to only one specific cause of mortality were analyzed. VOD-related death in the PBPC group. These data demonstrate a marked improvement in transplant-related mortality which is related to the use of PBPC. This Patients and methods effect has been almost entirely due to a reduction in mortality from hepatic veno-occlusive disease.Patient characteristics