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26 First-Remission Autograft forAML RELATIONSHIP OF PREAUTOGRAFT INTERVAL TO LEUKEMIA-FREE SURVIVAL To examine the relevance of preautograft delay, we reviewed our experience combined with that of six other series that have been reported. The data were from 95 patients whose characteristics are shown in Table 1. Cyclophosphamide plus TBI was the chosen ablative protocol for 58 patients; 23 received high-dose combination chemotherapy, and 14 underwent double autografts and high-dose chemotherapy. No measures were taken to treat the autograft in vitro in an attempt to remove residual leukemia. Twenty-nine patients experienced relapse, all but two of these occurring within 12 months of the autograft. Five patients died of causes other than leukemia. Figure 2 shows the overall predicted survival and leukemia-free survival rates at 5 years. The period of remission that had elapsed before the autograft was variable, even within treatment centers, in this group of patients. To assess the influence of preautograft delay on leukemia-free survival, the patients were divided into groupings whose delay was 0-4 months, 5-8 months, and 9-12 months. Excluded from the analysis were patients whose delays were longer than 12 months and patients who died of reactions. Predicted disease-free survival rates shown in Figure 3 are for the 31 patients in the 0- to 4-month delay group, 40 patients in the 5- to 8-month delay group, and for the 14 patients in the 9- to 12-month delay group. DISCUSSION As a strategy for maintaining remission in AML and an alternative to traditional chemotherapy, ablative treatment necessitating ABMT clearly merits consideration. Although 40-50% of patients have relapsed, relapses have been uncommon beyond 12 months after the autograft, suggesting that the pattern of relapse previously observed with chemotherapy is altered. Since the relapse rate so far is not higher than that of syngeneic-graft recipients with AML* in first remission, there is little reason to believe that problems of leukemia contamination of the autograft will be a priority in the immediate future. Preliminary clinical results of efforts to purge the marrow do not yet show an advantage over the unpurged results (7). Current results of autograft are encouraging and the toxicity is acceptable. Autograft may be more tolerable for patients and a better use of treatment resources than the alternatives of prolonged intensive chemotherapy (13,14). Improved methods of eradicating residual disease in the patient seem tobe a concern of immediate priority. Although augmented TBI has been relatively ineffective in reducing the relapse rate of patients who received allografts during relapse (15), these may be more successful if applied during remission. Equivalent chemotherapy used with allografting during first and second remissions has an impressive record of eradicating residual disease (16).
s o CO s •o « k. 3 Q. P CO l_ O — CO rr CO o c 03 O 01 CO c o CO o 'c 3 n ü E c E o c w 8 S S 03 ^ 10 CO -— Q.
Page 1: Autologous Bone Marrow Transplantat
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Page 7: To our colleagues, Drs. R. Lee Clar
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Page 12 and 13: X ABMT Pharmacological Manipulation
Page 14 and 15: XII ABMT C. INTERNATIONAL RANDOMIZE
Page 16 and 17: xiu ABMT Session IV - Breast Cancer
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Page 20 and 21: xuiii ABMT Effect of Interleukin 2
Page 23: Acknowledgments The publication of
Page 29 and 30: AML in First Remission 5 performed
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Page 34 and 35: 10 BAVC + ABMT in Patients With AML
Page 36 and 37: BAVC + ABMT in Patients With AML in
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Page 40 and 41: 16 Purged ABMT in CR of Acute Leuke
Page 48 and 49: 24 First-Remission Autograft forAML
Page 52 and 53: 28 First-Remission Autograft forAML
Page 57: Transplantation in CRI AML 33 DISCU
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Page 68 and 69: 44 ABMTin CRI program in CR1 is the
Page 70 and 71: 46 ABMTin CRI RESULTS The AML inves
Page 73 and 74: Leukemia: First Remission K A. Dick
Page 75 and 76: Panel Discussion: Session IA 51 DR.
Page 77: IB. Clinical Studies in Second- or
Page 80 and 81: 56 ABMTIn CR2 RESULTS OF VARIOUS TR
Page 82 and 83: 58 ABMTIn CR2 antibodies; for non-T
Page 84 and 85: 60 ABMT in Acute Nonlymphocytic Leu
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76 ABMT in AML With Monoclonal Anti
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78 ABMT in AML With Monoclonal Anti
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80 Mafosfamide Purging in Leukemia
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Autologous Bone Marrow Transplantat
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ABMT in CR2 Pediatric ALL 91 follow
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Ex Vivo Use of Monoclonal Antibodie
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Ex Vivo Marrow Purging 95 Table 1.
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De Viuo Marrow Purging 97 WBC-f- AN
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Conditioning Regimens Before Bone M
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Conditioning Regimens in AML 101 Le
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Conditioning Regimens in AML 103 co
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106 Double (Jnpurged ABMT in Leukem
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108 Double Unpurged ABMT in Leukemi
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770 Double (Jnpurged ABMT in Leukem
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7/2 Double Autografting in Acute Le
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114 Double Autografting in Acute Le
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120 Recovery After 4-Hydroperoxycyc
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122 Recovery After 4-Hydroperoxycyc
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Panel Discussion: Session IB 127 di
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Panel Discussion: Session IB 129 tu
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Magnetic Affinity Colloid Eliminati
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Magnetic Separation of Marrow Cells
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*r r- r» u. >>• O S ^ CO ai a> C
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4-Hydroperoxycyclophosphamide and V
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Chemopurging 145 incubation, the ce
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Chemopurging 147 To date, four pati
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Chemopurging 149 4-HC + VCR IC75 AM
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Decontaminating Bone Marrow With Me
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Merocyanine 540 Marrow Decontaminat
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Merocyanine 540 Marrow Decontaminat
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CALLA-Negative Clonogenic Cultures
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CALLA-Negatiœ Clonogenic BCell ALL
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CALLA-Negative Clonogenic BCell ALL
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164 Acetaldophosphamide Ex Vivo Che
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766 Acetaldophosphamide Ex Vivo Che
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168 Acetaldophosphamide Ex Viuo Che
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Detecting Residual Disease in Bone
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178 Pharmacological Manipulation an
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ID. Chronic Myelogenous Leukemia
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190 CML Chronic Phase Autografting
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196 CML Blast Crisis Autografting e
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Autologous Transplantation of Phila
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Autografting in Chronic Granulocyti
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Autografting in Chronic Granulocyti
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206 Panel Discussion: Session ID DR
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Natural History of Relapsed Hodgkin
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ABMT in Hodgkin's Disease 211 50%.
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ABMTin Hodgkin, 's Disease 213 (62%
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ABMT in Hodgkin's Disease 215 LLLLL
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Updated Results of CBV and Autologo
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CBV and ABMT in Hodgkin's Disease 2
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CBV and ABMT in Hodgkin 's Disease
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224 Chemotherapy and ABMT in Hodgki
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226 Chemotherapy and ABMTin Hodgkin
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232 ABMT for Advanced Hodgkin's Dis
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234 ABMTfor Advanced Hodgkin's Dise
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Hodgkin's Disease J. O. Armitage an
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Panel Discussion: Session IIA 239 D
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IIB. Non-Hodgkin's Lymphoma
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244 Salvage Chemotherapy for Lympho
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246 Salvage Chemotherapy for Lympho
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ABMT in Burkitt's Lymphoma 251 Tabl
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ABMT in Burkitt's Lymphoma 253 medi
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ABMT in Burkitt's Lymphoma 255 Heal
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ABMT in Burkitt's Lymphoma 257 •
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ABMT in Burkitt's Lymphoma 259 init
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ABMT in Burkitt's Lymphoma 261 11.
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264 Myeloma Biology and Therapy hig
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266 Myeloma Biology and Therapy mon
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265 Myeloma Biology and Therapy 5.
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270 BMT in Relapsed Diffuse Large C
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276 Transplantation for Malignant L
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Optimum Timing of Autologous Bone M
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ABMT Timing in Lymphoma 281 PATIENT
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3 o + + + + o LO T— T— LO co Tf
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ABMT Timing in Lymphoma 285 RESULTS
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co co I I I I I I I I I I 2 2 2 CD
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ABMT Timing in Lymphoma 289 Median
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ABMT Timing in Lymphoma 291 in a mi
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ABMT Timing in Lymphoma 293 Develop
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ABMT Timing in Lymphoma 295 53. Sto
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298 Treatment Strategies for NHL PA
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300 Treatment Strategies for NHL 10
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302 Treatment Strategies for NHL 2)
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304 Treatment Strategies for NHL al
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306 Treatment Strategies for NHL 31
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308 Panel Discussion: Session IIB m
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IIC. International Randomized Study
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314 Proposed International Adult Ly
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International Randomized Trial in N
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International NHL Trial 337 dispari
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International NHL Trial 339 cannot
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International NHL Trial 341 ORGANIZ
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Lymphoma T. Philip and G. Spitzer,
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IID. Purging and Detection
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348 Chemoimmunoseparation of T Lymp
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350 Chemoimmunoseparation of T Lymp
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352 Burkitt's Lymphoma Purging Assa
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354 Burkitts Lymphoma Purging Assay
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356 Burkitt's Lymphoma Purging Assa
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358 Burkitts Lymphoma Purging Assay
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360 Purging Methods in Burkitt's Ly
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366 Leukemia Cell Sensitivity to Im
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368 Leukemia Cell Sensitivity to Im
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370 Leukemia Cell Sensitiuity to Im
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372 Panel Discussion: Session IID D
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ABMTfor Neuroblastoma 377 sedimenta
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ABMT for Neuroblastoma 379 EX VIVO
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ABMTfor Neuroblastoma 381 PATIENTS
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Repeated High-Dose Chemotherapy Fol
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ABMT in Metastatic Neuroblastoma 38
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ABMT in Metastatic neuroblastoma 39
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394 Clnpurged ABMTfor Neuroblastoma
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396 Unpurged ABMTfor Neuroblastoma
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398 Unpurged ABMTfor Neuroblastoma
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ENSG 1—Randomized Study of High-D
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High-Dose Melphalan in Neuroblastom
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High-Dose Melphalan in Neuroblastom
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408 ABMTin 65 Patients With Neurobl
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410 ABMT in 65 Patients With. Neuro
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416 ABMTin 65 Patients With neurobl
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A Single Institution's Experience o
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ABMT in Neuroblastoma 421 procedure
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ABMT in Neuroblastoma 423 therapies
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426 Purged Marrow Engraftment in Ne
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Digital Image Analysis System for D
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Digital Image Analysis System 435 d
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Digital Image Analysis System 437 c
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Digital Image Analysis System 439 C
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Digital Image Analysis System 441 1
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444 Immune-magnetic Purging ofBurki
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450 Panel Discussion: Session III W
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452 Panel Discussion: Session III e
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High-Dose Chemotherapy Intensificat
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High-Dose Chemotherapy and ABMT in
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466 Treatment Strategies in Breast
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10 CO 0) I- m c o a. a. 3 W ? o k_
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476 Phase I and II Studies of Alkyl
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482 High-Dose Therapy and ABMT in B
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484 High-Dose Therapy and ABMT in B
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486 Immunodetection of Breast Carci
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ABMTfor Breast Cancer 491 only adju
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ABMT for Breast Cancer 493 Table 3.
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ABMTfor Breast Cancer 495 4. Eder J
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498 Occult Breast Cancer Cells in M
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504 Panel Discussion: Session IV DR
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506 Panel Discussion: Session IV a
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Detection of Bone Marrow Metastases
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Tumor Cell Detection 511 Two separa
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Tumor Cell Detection 513 immunofluo
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516 Etoposide and Cisplatin for Lun
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Lung Cancer G. Spitzer and H. Lazar
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Panel Discussion: Session V 525 com
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Panel Discussion: Session V 527 col
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Treatment of Advanced Melanoma With
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ABMT in Melanoma 533 Table 1. Three
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ABMT in Melanoma 535 mg/m 2 ). The
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Melanoma/ Sarcoma/ Carcinoma R. Ben
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Panel Discussion: Session VI 539 re
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VII. Brain Cancer
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544 Carmustine and ABMT for Maligna
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546 Carmustine and ABMTfor Malignan
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Pilot Study of High-Dose Carmustine
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High-Dose Carmustine and Transplant
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High-Dose Chemotherapy With Autolog
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High-Dose Therapy of CNS Gliomas Ta
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High-Dose Therapy of CHS Gliomas 56
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High-Dose Therapy of CHS Gliomas 56
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566 Panel Discussion: Session VII A
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VIII. New Regimens
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572 Clinical Intensification Regime
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574 Clinical Intensification Regime
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Clinical Intensification Regimens f
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Clinical Intensification Regimens f
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High-Dose Busulfan and Cyclophospha
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Busulfan + Cyclophosphamide in Chil
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The Intensive Use of Carmustine Wit
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Intensive Use ofCarmustine 591 6. P
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594 BEAM: Cytoreductive Regimen for
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596 BEAM: Cytoreductiue Regimen for
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602 Total Body Irradiation, Cytarab
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604 Total Body Irradiation, Cytarab
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606 Panel Discussion: Session VIII
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Herpesvirus Infections After Autolo
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Herpesvirus Infections 611 Table 2.
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Herpesvirus Infections 613 contrast
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616 Peripheral Stem Cell Transplant
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CO ^ CO COi-t'ycOi-T-CO O E « to T
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fc CD rr ^ O < c E + o — ce S O O
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o E ra o CD .Q Û ra co CL o E o 15
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634 Toxic Deaths in ABMT PATIENTS A
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636 Toxic Deaths in ABMT Table 2. D
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638 Toxic Deaths in ABMT defined an
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640 Infectious Complications ofABMT
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Infectious Complications of Autolog
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Infections in ABMT 649 Table 1. ABM
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Infections in ABMT 651 herpes simpl
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Newer Antibiotic Regimens in Cancer
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Antibiotics in Cancer Patients 655
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Antibiotics in Cancer Patients 657
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660 Amphotericin B for Neutropenic
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662 Amphotericin B for Neutropenie
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664 Amphotericin B for Neutropenie
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666 IVIg in ABMT in autologous tran
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668 IVlg in ABMT 25. Neiman PE, Ree
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670 Natural Killer Cells and Transp
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672 Natural Killer Cells and Transp
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Autologous Transplantation of Circu
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678 Transplantation of Circulating
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Restoration of Hematopoietic Functi
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Peripheral Stem Cell Transplants 68
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Peripheral Stem Cell Transplants 68
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688 Peripheral Blood Stem Cell Tran
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694 Bronchoscopy in Marrow Transpla
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696 Bronchoscopy in Marrow Transpla
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698 T Lymphocyte CFU After ABMT cer
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700 T Lymphocyte CFCI After ABMT RE
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702 T Lymphocyte CFU After ABMT CMV
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Supportive Therapy H. Vriesendorp a
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X. Molecular Biology
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770 Human ADA in Monkeys years in a
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7/2 Human ADA in Monkeys supernatan
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714 Human ADA in Monkeys Number of
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776 Human ADA in Monkeys primate ma
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718 Electric Field-Mediated DMA Tra
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720 Electric Field-Mediated DNA Tra
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Aberrant Gene Expression in Acute M
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+ z + + + les •ras a z E i ü (0
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Aberrant Gene Expression in AML 727
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Aberrant Gene Expression in AML 729
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732 Clonal Detection of Remission p
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734 Clonal Detection of Remission K
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736 Clonal Detection of Remission 3
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Summary D. W. van Bekkum Attempts t
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Summary 741 T cell-depleted bone ma
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Summary 743 hybridization technique
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Summary 745 GENETIC THERAPY The las
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748 Concluding Remarks time of the
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750 Contributors and Participants F
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754 Contributors and Participants P
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756 Contributors and Participants A
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758 Contributors and Participants P
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762 Contributors and Participants H
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764 Contributors and Participants A
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766 Contributors and Participants G
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770 Contributors and Participants S
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772 Contributors and Participants C
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776 Contributors and Participants D
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