Autologous Bone Marrow Transplantation - Blog Science Connections

Double Unpurged ABMT in Leukemias 107
Marrow Procedures
Marrow was aspirated during CR up to collection of a minimum of 2 x 10 8
medullary cells/kg. Marrow was stored in liquid nitrogen after cryopreservation
with dimethyl sulfoxide until clinical use. After the first ABMT, when granulocytes
numbered more than 1000/mm 3
and platelets more than 100,000/mm 3 , a
second marrow collection was done and the marrow cryopreserved. The
second marrow was used for the second transplantation; no in vitro purge was
used.
Supportive Care
Patients were managed in single rooms with reverse isolation. All had had a
right atrial indwelling catheter inserted before admission. They received
parenteral nutrition if needed and broad-spectrum intravenously administered
antibiotics if they became febrile. Blood transfusions were done to maintain
hematocrit at more than 30% and platelets higher than 20,000/mm 3 . All blood
products, except marrow, were irradiated at 15 Gy before transfusion.
RESULTS (Table 2, Fig 1)
Acute Lymphoblastic Leukemia
Five of the six patients (83%) who were in relapse at the time of the first
ABMT achieved a CR after melphalan administration. One died of pneumonia 1
month after the procedure while in CR. Two patients had relapses early at 1 and
3 months and did not receive a second ABMT. Two underwent a second
procedure after a conditioning regimen by CBV; both relapsed subsequently,
one 9 and the other 17 months post-ABMT. Of the six patients who were grafted
Table 2. Antileukemic Response, Relapse, and Survival After Autologous
Bone Marrow Transplantation
Status n CR
Death
in CR Relapse CCR Alive
AML in relapse 16 11 3 6 2 3
(52, 62, 63+)
ALL in relapse 6 5 1 4 —
AML in first CR 13 1 6 6 9
(5,6, 9,12,15,
15, 20, 22, 42+)
ALL in CR 6 — — 3 3 3
(23, 29, 36+)
Abbreviations: AML, acute myeloid leukemia; ALL, acute lymphoid leukemia; CR,
complete remission; CCR, continuous complete remission; ( ), follow-up in
months
post-ABMT.