Autologous Bone Marrow Transplantation - Blog Science Connections

ABMT in 65 Patients With Neuroblastoma 413
grafting and the 6 patients still in induction treatment are included as shown
in Figure 3, the projected overall progression-free survival at 27 months
postdiagnosis is 24%, compared with 1% for the same cooperative group's
previous experience.
Among the 44 patients purged with the Kemshead technique, the
median time to reach a WBC count of 1000 post-ABMT was 23 days. The
median time to reach a count of 500 polynuclear cells was 24 days; 200
polynuclear cells, 19 days; and 50,000 platelets, 39 days. The capability of
immunomagnetically purged autologous bone marrow graft to repopulate
marrow after TBI was thus demonstrated. Five graft failures were, however,
observed in this group and are reported in detail elsewhere (Favrot et al. [25],
and the above-named chapter in this volume).
The toxicity of this particular association of continuous infusion of
vincristine, high-dose melphalan, and TBI has been reported in detail (9). In
this group of patients, the following features were of note:
In 50% of the patients, continuous infusion of vincristine produced some
toxicity (e.g., leg pain lasting up to 3 days, maxillary pain, and mild ileus [25
patients ]). Oral mannitol (100 cc/kg/day) as laxative was generally sufficient
to control these problems in 20% of these patients. One patient had a small
bowel obstruction on day 26, but the role of vincristine in this is not certain
because intensive therapy was given only 1 month following this patient's
abdominal surgery. Other toxic reations were related specifically to the
4 1 1 1 1 1 1 1 1 r-
Diagn. 3 6 9 12 15 18 21 24 27 m
Figure 3. Survival of stage IV patients 1 year old and older in two groups of patients treated
during two consecutive periods in the same cooperative group (no selection and no
exclusion during the period considered).