Autologous Bone Marrow Transplantation - Blog Science Connections

284 ABMT Timing in Lymphoma
ABMT only at relapse or treatment failure). However, most patients refused
randomization and preferred to choose arm 1 or arm 2, and the protocol was
therefore revised, IRB approval obtained, and patients were then given a
choice of arm 1 or arm 2.
Fourteen patients elected to have ABMT while they were in CR (no
evidence of disease by physical examination or roentgenographic analysis) or
partial remission (PR) (greater than 50% reduction of tumor mass but residual
mass detected by physical examination or roentgenographic analysis). Thirteen
patients elected to continue on the L-17M protocol, among them five
patients who remain in CR at 62+, 44+, 28+, and 18+ months (two patients).
Eight patients had progressive disease or relapsed on the L-17M protocol
(arm 2). Six of these eight patients were able to receive a transplant, and the
other two died of rapid disease progression. The initial response to L-17M
and the number of months these patients remained in CR is given in Table 1.
All six patients who underwent transplantation in relapse showed significant
improvement, but all six patients have died. Eleven patients with non-
Hodgkin's lymphoma who had relapsed on other treatment also underwent
transplantation. Their clinical course and treatment prior to considering
ABMT are summarized in Table 2.
Patients were evaluated for potential dental problems before transplantation.
Dental cavities and infected teeth were treated. Plastic dental molds
were made for possible use in the event of gum bleeding and subsequent
fluoride treatment of teeth. Patients with a residual tumor mass after
induction chemotherapy received radiation boosts to the area of bulky disease
(usually 3 Gy/day for 4 days). Patients were then admitted to a single room for
transplantation. One week of prophylactic Bactrim double-strength by mouth
twice a day was given before ABMT. All patients with previous herpes simplex
infection or high viral titers of herpes simplex also received acyclovir intravenously
(35). Hyperfractionated TBI (total dose 13.2 Gy) was given in 11
fractions over 4 days (24,25). Intravenous hydration was started, and patients
received cyclophosphamide for 2 days at 60 mg/kg/day. The patient's
cardiac and urinary functions were carefully monitored, and after 48 hours
the patient's cryopreserved marrow was thawed in a water bath at the bedside
and rapidly reinfused without any treatment. Hydration was maintained until
hemoglobinuria subsided (the few RBCs present in the cryopreserved
marrow are lysed during the thawing procedure). Moderate-to-severe
mucositis was managed with frequent mouth care and antifungal medications.
Patients were placed on total parenteral nutrition until they were thought
able to eat. All blood products were irradiated with 30 Gy to prevent
transfused lymphocyte-mediated graft-versus-host disease (36). Patients
usually required a 5- to 6-week hospital stay and were then followed as
outpatients. Prophylaxis for Pseudomonas carinii was used. Doublestrength
Bactrim (twice daily by mouth) was begun 50 days after ABMT and
given for 90 days with frequent monitoring of the complete blood count.