Autologous Bone Marrow Transplantation - Blog Science Connections

BEAM: Cytoreductiue Regimen for Lymphomas 595
Table 1. Histologic Characteristics of Patients' Non-Hodgkin's Lymphomas
Non-Hodgkin's Lymphoma
No. of Patients
High-grade (23)
Burkitt 13
Lymphoblastic 4
Immunoblastic 6
Intermediate-grade (18)
Follicular large cells 1
Diffuse mixed 9
Diffuse large cells 6
Diffuse small cells 2
Low-grade (4)
Follicular mixed 1
Follicular small cells 3
Patients or parents were fully informed of the protocol risks and gave
informed consent in the presence of at least three collaborators.
Bone marrow harvesting and freezing procedures were performed as
previously reported (9,10); 24 marrows were purged, either with monoclonal
antibodies ( 11 ) or with mafosfamide. In 28 cases, the marrow was unpurged.
Bone marrow was harvested from 15 patients in first CR, at relapse in 28, and
during first PR in 7 patients; 2 patients had disease progression with bone
marrow involvement when the marrow was taken.
Patients were isolated in a sterile room but not always in a laminar air flow
unit. They all received standardized gut decontamination, except for the
patients in London, and bacteriological survey and transfusion policies were
used as previously described by the participating centers.
The BEAM regimen (Table 2) consisted of carmustine given over 30
minutes, diluted in 100 cc of dextrose; etoposide, 100 mg/m 2
administered
intravenously every 12 hours over 30 minutes, diluted in 200 ml of dextrose;
cytarabine, 100 mg/m 2 intravenously every 12 hours over 30 minutes in 200
ml dextrose; and melphalan as intravenous bolus over 5 minutes. Forced
diuresis was instituted at least on the last 3 days with a 3 1/m 2
dextrose
hydration. On day 7, or at least 24 hours after melphalan and 48 hours after
the last etoposide administration, autologous bone marrow was reinfused.
RESULTS
Response Rate
Details of response according to status before ABMT are shown in Table
3. For the 26 patients whose response was évaluable, the overall response
rate was 19 of 26 patients (73%), with responses from 13 of 19 NHL patients
(68%), and 6 of 7 Hodgkin's disease patients (85.5%). In the group of seven
NHL patients with resistant relapse or progressive disease, however, only two