Autologous Bone Marrow Transplantation - Blog Science Connections

ABMT in 65 Patients With Neuroblastoma 411
it was impossible to use disease-free survival curves. We therefore constructed
curves using the Kaplan-Meier method only for probability of
nonprogression. Nonprogression or progression of the disease was defined
either clinically or with bone marrow, bone scan, or biological evaluation.
Patients who died of complications were considered in the curves as
progressive at the time of death.
RESULTS
For the 59 patients who completed induction therapy, the results can be
summarized as follows:
Ten (17%) were not grafted because of bone marrow progression and
lack of allogeneic donors (three), death at induction (four, two of whom were
in CR) or during surgery (one), and parents' refusal (two). AH these patients
are dead or have relapsed.
Forty-nine patients underwent consolidation treatment with vincristine,
melphalan, and fractionated TBI, with the following results:
Thirty-one patients were in PR at time of BMT. Four died of toxic
reactions before day 90 post-ABMT, one of veno-occlusive disease (VOD),
two of pneumonitis, and one of gastric bleeding. One patient had a lateoccurring
toxic reaction on day 413, with fatal bleeding related to persistent
thrombocytopenia. Three patients had progressive disease and died 147,
190, or 192 days post-ABMT. Nine relapsed between 3 and 12 months
post-BMT and died 172, 179, 231, 323, 358, 388, 389, 538, or 631 days
post-BMT. Fourteen patients are alive and progression free 29-1118 days
post-BMT (median, 461 days). However, the probability of nonprogression at
20 months postgraft is 34%, as shown in Figure 2.
Seven patients received grafts while in VGPR. Three died of toxicity 28,
36, or 62 days postgraft (two of VOD and one of cytomegalovirus). One
relapsed 17 months postgraft and is alive with disease more than 845 days
post-BMT; and three patients are alive and nonprogressing 383+, 474+, and
800+ days post-BMT.
Eleven patients received grafts during CR. One died of toxicity on day 42
of encephalitis and one on day 52 of VOD; one Algerian child was lost to
follow-up on day 50 when he had VOD, and he is considered as dead in our
data. One patient relapsed at 5 months postgraft and died 278+ days
postgraft. One relapsed at 7 months and died in relapse on day 236, and one
relapsed at 11 months and died with disease 452+ days postgraft. Four
patients are still alive and progression-free 90+, 145+, 202+, and 950+ days
post-BMT. One patient was lost to follow-up.
As shown in Figure 2, the probability of nonprogression at 20 months
postgraft of the 18 patients grafted during VGPR or CR is 37%.
The projected progression-free survival of the whole group of 49 patients
at 35 months postgraft is 33% (Fig 2). If the 10 patients excluded from