Autologous Bone Marrow Transplantation - Blog Science Connections

478 Phase I and II Studies of Alkylating Agents in Breast Cancer
Supportive Care
Patients were housed in single rooms in reverse isolation. They received
irradiated blood products (15 Gy) to maintain their platelet count at more
than 20,000/mm 3
and their hematocrit at more than 30%. If they became
febrile, they were treated promptly with broad-spectrum antibiotics, followed
by empiric i.v. amphotericin B if the fever persisted more than 48 hours.
Parenteral nutrition was given when the patient's oral intake was less than 50%
of the standard caloric requirement.
Evaluation of Extrahematologic
Toxicity
Mucositis was considered as mild if the patient complained of soreness
during meals, moderate if the patient was unable to eat, and severe if the pain
required narcotics. Diarrhea was coded as mild for watery stools of less than
500 ml/day, moderate if diarrhea was more than 500 ml with pain, and severe
when associated with hemorrhage.
RESULTS
Antitumors! Response
Two patients died during the first month after ABMT. Six patients were
évaluable: four had a complete response, one a partial response, and one had
stable disease. Median duration of responses was 5.5 months (range, 3-24
months).
Overall, of the nine patients évaluable after 1 month, six experienced
disease progression, and three are in continuous complete remission with a
short follow-up. Among the six patients who relapsed, two had metastatic
cancers that progressed, and four patients had a thoracic recurrence, with
skin and subcutaneous involvement.
Hematologic Toxicity
As Table 2 shows, all patients had evidence of engraftment, granulocytopenia
(fewer than 500/granular leukocytes/mm 3 ) lasting a median of 14
days (range, 8-37 days), and thrombocytopenia (fewer than 50,000
platelets/mm 3 ) a median of 27 days (range, 20-50 days).
Extrahematologic Toxicity
Two patients with multiresistant metastasis died early of viral infection
and heart failure. Moderate or severe mucositis occurred in 6 of the 11
patients, and moderate or severe diarrhea in 4 of the 11 patients. Extrahematologic
toxicity was neither more frequent nor more severe in patients receiving
additional alkylating agents in addition to melphalan. One patient,
conditioned with mitoxantrone, cyclophosphamide, and melphalan, developed
renal failure hours after the marrow infusion; his renal function returned