Reduced mortality following bone marrow transplantation for breast cancer with the addition of peripheral blood progenitor cells is due to a marked reduction in veno-occlusive disease of the liver

Abstract

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

High-Dose Chemotherapy of Cyclophosphamide, Thiotepa and Carboplatin (CTCb) followed by Autologous Stem-Cell Transplantation as a Consolidation for Breast Cancer Patients with 10 or more Positive Lymph Nodes: a 5-Year follow-Up Results

“…This was attributed to the selection of a noncarmustine-based transplant protocol, the use of peripheral blood stem-cell support, and better supportive care. This low treatment-related mortality was in accordance with other studies (8,10,11,13,18,21,24).…”

Marked reduction in the incidence of hepatic veno-occlusive disease after allogeneic hematopoietic stem cell transplantation with CD34+ positive selection

“…[19][20][21][22][23][24] Only in the autologous setting, one study has reported a lower incidence of VOD after transplantation with both bone marrow and peripheral blood stem cells than after transplantation with bone marrow stem cells alone. 25 On the other hand, although the use of MTX for GVHD prophylaxis has emerged as a potential risk factor for VOD in one series, 26 several large studies have failed to show any association. [4][5][6] However, all these variables were associated with the risk of VOD by univariate analysis in our series and they had a heterogeneous distribution.…”

Sinusoidal Obstruction Syndrome (Hepatic Veno-Occlusive Disease)

“…[144][145][146] Glutamine supplementation, use of peripheral blood progenitor cells as opposed to those derived from the bone marrow, and T-cell depletion as prophylaxis against graft-versushost disease have been reported as having reduced incidence of SOS. 147,148 In the pediatric population undergoing HSCT, a prophylactic regime of enoxaparin or ursodeoxycholic acid and vitamin E has been of potential value. 149 Lastly, aggressive fluid management and control of fluid balance during the course of HSCT are essential.…”