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494 ABMT for Breast Cancer approach in metastatic breast cancer have been limited, as reviewed recently by Souhami and Peters (5). The largest trials have employed either single agents not usually used as treatment for metastatic breast cancer (6-8) or combinations of multiple alkylating agents (4). The latter approach seems to be the most encouraging, resulting in a significant number of CRs. However, the relative contributions of the individual agents have not been addressed. The preliminary trial reported here demonstrates that high-dose cyclophosphamide alone may produce responses in patients with breast cancer refractory to standard doses of the same drug but is unlikely to result in a significant number of CRs. Since survival benefit often depends largely on attainment of CR, a second drug was added to the treatment regimen in this trial. Even though carmustine in phase 11 studies has only modest activity against breast carcinoma, its addition to cyclophosphamide has resulted in CRs in two of four patients treated thus far. Although more patients are needed for confirmation, our results support the hypothesis that multiple high-dose alkylating agents may be additive or even synergistic in the treatment of metastatic malignancies. The toxicity of this aggressive approach, though significant, was tolerable in the patients with good pretransplant performance status. The treatment cannot be recommended for those with significant functional impairment. The shorter platelet recovery time of patients receiving cyclophosphamide alone suggests that endogenous marrow recovery played a significant role in hematopoietic reconstitution and supports the studies of Smith et al. (9) indicating that autografting is unnecessary with this regimen. However, the platelet recovery time of patients treated with cyclophosphamide plus carmustine was identical to that of patients at our institution autografted after marrow-lethal doses of cyclophosphamide and total body irradiation, suggesting the need for stem cell rescue. Although this preliminary study resulted in a high response rate, the median duration of response was disappointingly short. The predominance of local recurrences in relapsing patients indicates that the high-dose drug regimens employed here failed to eradicate endogenous tumor. Since the drug doses used are near the limit of their nonhematologic tolerance, it is likely that either additional drugs or alteration of the timing of the procedure will be necessary to achieve more meaningful disease control. REFERENCES 1. Henderson IC. In Breast Cancer: Diagnosis and Management, BonadonnaG.ed. Wiley, New York, 1984:247. 2. Frei E, Canellos GP. Am J Med 1980:69:585. 3. Peters WP. In Autologous Bone Marrow Transplantation: Proceedings of the First International Symposium, Dicke KA, Spitzer G, Zander AR, eds. The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston, Houston, 1985:189.
ABMTfor Breast Cancer 495 4. Eder JP, Antman K, Peters W, Henner WD, Elias A, Shea T, Schryber S, Andersen J, Come S, Schnipper L, Frei 111 E. J Clin Oncol 1986;4:159-2. 5. Souhami R, Peters W. Clin Haematol 1986:15:219. 6. Schnell FC, Di Stefano A, Spitzer Q. Proceedings of the American Association for Cancer Research 1981:C521. 7. Tannir N, Spitzer G, Schnell FC, Legha S, Zander A, Blumenschein G. Cancer Treat Rep 1983:67:599. 8. Herzig RH, Phillips GL, Lazarus HM, Wolff SN, Fay JW, Hurd DD, Spitzer TR, Herzig GP. In Autologous Bone Marrow Transplantation: Proceedings of the First International Symposium, Dicke KA, Spitzer G, Zander AR, eds. The university of Texas M. D. Anderson Hospital and Tumor Institute at Houston, Houston, 1985:197. 9. Smith IE, Evans BD, Harland SJ, Robinson BA, Yarnold JR, Glees JG, Ford HT. Cancer Chemother Pharmacol 1985:14:120.
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Autologous Bone Marrow Transplantat
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To our colleagues, Drs. R. Lee Clar
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via ABMT Autologous Bone Marrow Tra
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X ABMT Pharmacological Manipulation
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XII ABMT C. INTERNATIONAL RANDOMIZE
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xiu ABMT Session IV - Breast Cancer
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xui ABMT Panel Discussion: Session
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xuiii ABMT Effect of Interleukin 2
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Acknowledgments The publication of
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AML in First Remission 5 performed
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AML in First Remission 7 than 50% o
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10 BAVC + ABMT in Patients With AML
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BAVC + ABMT in Patients With AML in
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14 BAVC + ABMTin Patients With AML
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16 Purged ABMT in CR of Acute Leuke
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24 First-Remission Autograft forAML
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Transplantation in CRI AML 33 DISCU
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36 ABMT in ALL compared the results
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38 ABMT in ALL were administered un
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40 ABMT in ALL CR1 patients receive
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42 ABMT in ALL 19. Rizzoli V, Mango
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44 ABMTin CRI program in CR1 is the
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46 ABMTin CRI RESULTS The AML inves
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Leukemia: First Remission K A. Dick
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Panel Discussion: Session IA 51 DR.
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IB. Clinical Studies in Second- or
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56 ABMTIn CR2 RESULTS OF VARIOUS TR
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58 ABMTIn CR2 antibodies; for non-T
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60 ABMT in Acute Nonlymphocytic Leu
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70 ABMT in AML With Monoclonal Anti
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80 Mafosfamide Purging in Leukemia
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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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Page 479 and 480: High-Dose Chemotherapy Intensificat
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Page 522 and 523: 498 Occult Breast Cancer Cells in M
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Page 533 and 534: Detection of Bone Marrow Metastases
Page 535 and 536: Tumor Cell Detection 511 Two separa
Page 537: Tumor Cell Detection 513 immunofluo
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Page 547 and 548: Lung Cancer G. Spitzer and H. Lazar
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Page 555 and 556: Treatment of Advanced Melanoma With
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Page 561 and 562: Melanoma/ Sarcoma/ Carcinoma R. Ben
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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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