Rapid and complete hemopoietic reconstitution following combined transplantation of autologous blood and bone marrow cells. A changing role for high dose chemo‐radiotherapy?

Abstract

The role of high dose chemo-radiotherapy with autologous bone marrow transplantation in the treatment of neoplasia remains to be clearly defined. Because of the iatrogenic morbidity, mortality and high cost of the supportive care required during the post-transplantation period of prolonged marrow aplasia, intensive therapy remains a sophisticated procedure lacking proper evaluation in clinical trials. We report here that when autologous bone marrow cells are supplemented with a small number of peripheral blood nucleated cells collected after prior myelosuppressive chemotherapy, complete hematological recovery is so prompt that myeloid toxicity appears no longer the major limiting factor of high-dose chemo-radiotherapy. The increased therapeutic index made possible by the procedure will allow us to address the issue of whether intensive cytoreductive therapy can be useful as initial treatment of selected tumors with curative intent.

High-dose mitoxantrone + melphalan (MITO/L-PAM) as conditioning regimen supported by peripheral blood progenitor cell (PBPC) autograft in 113 lymphoma patients: high tolerability with reversible cardiotoxicity

“…[5][6][7][8][9][10][11][12] The wide applicability of this procedure has been possible due to the advantages offered by peripheral blood progenitor cells (PBPC) in reducing hematological toxicity. [13][14][15][16] Correspondence: C Tarella, Cattedra di Ematologia, Via Genova 3, 10126 Torino, Italy; Fax: 0039-011-696.3737 2 The ease deriving from the excellent tolerability of PBPC procedures probably slowed down the efforts aimed to look for innovative and possibly more effective conditioning regimens. In fact, most autograft programs employed nowadays are based on conditioning regimens designed several years ago, such as TBI + cyclophosphamide (CY), or regimens containing nitrosurea or melphalan (L-PAM), such as BEAM, CBV or BEAC.…”

Progenitor cell yields are frequently poor in patients with histologically indolent lymphomas especially when mobilized within 6 months of previous chemotherapy

“…Autologous bone marrow as a source of stem cells has been largely replaced by peripheral blood stem cells (PBSC) as this results in more rapid haematological regeneration [7][8][9] with attendant cost savings. 10 It is generally agreed that there are progenitor cell threshold requirements below which haemopoietic recovery can be severely delayed particularly for the platelet lineage.…”

A review of radiation countermeasures focusing on injury-specific medicinals and regulatory approval status: part I. Radiation sub-syndromes, animal models and FDA-approved countermeasures

“…Without any treatment, death may occur within 2-4 weeks post-irradiation. Therefore, reconstitution or protection of the hematopoietic systems is a foremost concern (Gianni et al 1989;Laterveer et al 1996).…”