Autologous Bone Marrow Transplantation - Blog Science Connections

516 Etoposide and Cisplatin for Lung Cancer
carcinoma of the lung to determine the maximum dose of etoposide that could
be administered safely in conjunction with high-dose cisplatin and autologous
bone marrow reinfusion.
MATERIALS AND METHODS
Fifteen lung cancer patients representing 18 treatment courses were
evaluated. Three patients had small cell carcinoma, two of whom had not
achieved a complete remission with conventional combination chemoradiation
therapy and one who had relapsed after attaining remission. Six patients had
surgically unresectable non-small cell cancer previously untreated, and six had
active non-small cell disease after therapy. The median age for all patients was
59 years (range, 38-68 years). Twelve of these patients were men and three
were women. No patient had evidence of active infection or tumorous
involvement of the bone marrow. All patients had a Karnofsky performance
status of at least 60%, an anticipated survival untreated greater than 8 weeks,
measurable disease at physical examination or on external imaging, and no
evidence of major organ system dysfunction not directly attributable to tumor.
All patients had undergone a bone marrow harvest and cryopreservation
procedure at least 4 weeks after completing any previous cytotoxic therapy. The
marrow was frozen using previously described techniques and was stored in the
liquid phase of a liquid nitrogen refrigerator until used (28). This protocol was
approved by the Institutional Review Board for Human Subject Investigation of
the University Hospitals of Cleveland, and all patients gave written informed
consent.
At the start of therapy, patient evaluation included a complete history,
physical examination, tumor measurement studies, complete blood count,
serum tests of liver and renal function, 24-hour urinalysis for creatinine
clearance, and audiometry. Patients were treated in single hospital rooms
without specialized isolation procedures. Central venous catheters, parenteral
alimentation, broad-spectrum antibiotics, and irradiated (30 Qy) bloodcomponent
support were used as indicated clinically. Persons with a history of
"cold sores" or serum anti-herpes simplex antibody titers greater than 1:8
received intravenous acyclovir for 14 days (day T-l through T+12). Time
intervals were calculated from day 0, the day of marrow transplantation. The
Eastern Cooperative Oncology Group (ECOG) criteria of response and toxicity
were used to grade antitumor effect and organ system damage, respectively
(except for hematologic dysfunction) (29). Frozen bone marrow was transported
to the bedside in a liquid nitrogen-containing vessel for reinfusion 2 days
after the final dose of chemotherapy. The marrow was thawed in a 37° C water
bath and directly injected through a central venous catheter over 10 minutes
without using blood filters.
The treatment schema is shown in Table 1. Patients received intravenous
hydration with 0.9% saline beginning 12 hours before the first dose of