Autologous Bone Marrow Transplantation - Blog Science Connections

BAVC + ABMT in Patients With AML in CR
monoclonal antibody (MAb), underwent ABMT while in CR1 after in vitro
purging with S4-7 MAb and complement (6).
All patients were treated in single rooms and received bowel decontamination
with nonabsorbable antibiotics. All blood products were irradiated before
infusion to prevent possible graft-versus-host reaction. Broad-spectrum antibiotics
were given for fever during aplasia, and amphotericin B was added for
documented systemic fungal infection or for persistent fever during aplasia.
Patients who were at risk for the recurrence of herpes simplex virus infection
received prophylactic oral acyclovir. Before starting pretransplant chemotherapy,
a central venous catheter was inserted for the administration of fluids,
antibiotics, and blood products in all patients. Maintenance chemotherapy after
ABMT was not employed.
RESULTS
All 39 patients obtained hematologic reconstitution (Table 1 ). No relationship
was observed between the time of recovery of granulocytes and the
number of transplanted marrow cells, which contrasts with our experience that
platelet recovery seems to be related to the number of reinfused mononuclear
cells. A longer delay in platelet recovery was observed in the four patients who
received marrow-purged cells.
Toxic reactions to the BAVC regimen were acceptable with no lifethreatening
problems (Table 2). Nausea and vomiting were common and seven
patients developed severe mucositis, which made them unable to eat. Thirtytwo
patients were febrile during aplasia (in 14 [44%], fever was associated with
positive cultures for bacteria) and responded to broad-spectrum antibiotic
therapy. In one case of resistant fever, fungal pneumonitis was identified and
successfully treated with amphotericin B. Clinical symptoms of pulmonary
distress, including rapidly progressing dyspnea, dry cough, and tachypnea were
observed in five out of nine patients younger than 15 years old 2-3 months
post-ABMT. Pulmonary function test revealed arterial hypoxemia, marked
Table 1. Hematologic Recovery After Autologous Bone Marrow Transplantation
in AML Patients With BAVC Conditioning
Mononuclear Cells PMN >500 ß\ PLTS >50,000 ß\ Hospitalization
l n , u s e d * ins/kg (in days) (in days) (in days)
Remission
Status median (range) median (range) median (range) median (range)
CR1 1.2 (0.13-2.8) 18 (10-31) 46 (16->250) 26 (21-42)
(30 patients)
CR2 1.7 (0.25-3) 15 (11-34) 38 (18->100) 26 (21-39)
(9 patients)
Abbreviations: A ML, acute myelogenous leukemia; BAVC, BCNU, amsacrine, VP-
16-213, cytarabine; CR1, first complete remission; PMN, polymorphonuclear
neutrophils; PLTS, platelets; CR2, second complete remission.