Autologous Bone Marrow Transplantation - Blog Science Connections

634 Toxic Deaths in ABMT
PATIENTS AND METHODS
From 1980 to 1985, 103 courses of high-dose chemotherapy followed
by ABMT were administered in our unit to 100 patients with various
malignancies (Table 1). Three patients received two courses each. Seventy
patients were males and 30 were females; their median age was 19 ± 15 years,
and 51 patients were younger than 15 years old.
The patients were categorized according to their status at grafting into
one of three groups: selected poor prognosis at first complete remission
(CR), 20 patients; sensitive relapse, 40 patients; and resistant relapse, 40
patients. The conditioning regimens used, which were varied, included TBI in
addition to chemotherapy for 38 patients, high-dose melphalan alone or in
combination, 66 patients, and high-dose cyclophosphamide (with TBI or in
combination), 29 patients. For each patient, a vascular access was fitted with
two silicone rubber catheters, the first one for parenteral nutrition, the second
one for transfusions, antibiotics, and other possible supportive therapies.
Fifty-eight courses were administered in a sterile-care unit with laminar
air flow and 45 in conventional rooms, but all the patients were treated by the
same team and received identical supportive care. When a patient developed
a temperature of 38° C or greater, he was examined for signs of infection;
blood and urine cultures were taken whenever antibiotic therapy was instituted.
The initial antibiotic regimen was based on the previous bacterial results
(oral, gut, skin) obtained routinely twice a week. The usual patient
surveillance also includes daily ionograms and blood counts and, twice
weekly, liver function tests, a urine chemical study, and chest x rays. Critically
ill patients were transferred to the intensive care unit.
To optimize the study of adverse reactions, postmortem examination
was performed, if possible, for every patient who died, early or later, after
ABMT.
Table 1. Types of Malignancies
Tumor Type
Number
Lymphomas 41
Neuroblastomas 15
Germinal tumors 11
Ewing's tumors 10
Soft tissue sarcomas 7
Small cell lung cancers 5
Other tumors 11