Autologous Bone Marrow Transplantation - Blog Science Connections

Toxic Deaths in ABMT 635
RESULTS
Fifty-nine patients went into CR after ABMT, 23 achieved partial
remission (PR), and 17 did not respond to chemotherapy; four courses were
unevaluable. Overall, the long-term persisting CR rate was 23% (23 patients),
with a median continuous complete remission follow-up of 34 ± months
(range, 12-67 months).
Death was considered to be toxic when not a result of the tumor. Toxic
deaths were separated into early toxic deaths (before the recovery of a
neutrophil count of 500/ml, i.e., 0-30 days in general) and delayed toxic
deaths (after recovery from granulocytopenia).
Despite the difficulty of establishing the accurate cause of every death,
we chose from among the several potentially lethal events for each patient a
primary cause of death. The fatal complications in the early and late periods
are presented in Tables 2 and 3. Other events are also specified.
The fatal complications were: aspergillosis (eight patients), venoocclusive
disease (VOD) (five patients), viral interstitial pneumonia (three
patients), central nervous system hemorrhage (three patients), cyclophosphamide-related
cardiac failure (two patients), systemic candidiasis (two
patients), and toxic hepatitis (one patient). The cause of death could not be
determined for two patients.
The status of patients at the time of toxic death differs between the early
and late periods. From 0 to 30 days after ABMT, toxic death occurred in 19
patients. Their pre-ABMT statuses were resistant relapse (RR) in 11 patients,
sensitive relapse (SR) in 6, and CR in 2. Among these patients, seven were in
CR at the time of death. From days 30 to 100 after ABMT, toxic death
occurred in nine patients. Their pre-ABMT status was RR in two patients, SR in
five, and CR in two. Six patients were in CR at the time of death.
DISCUSSION
Our toxic death rate is within the range of other studies or a little higher,
perhaps because of the high proportion of patients in RR who had a low
Karnofsky scale.
The principal cause of death appears to be infectious in origin.
Aspergillosis occurred in nine patients, eight of whom died despite specific
early therapy with amphotericin B. The cause of failures may be explained by
the frequency of disseminated forms of aspergillosis in six of the nine patients
and multiresistant Aspergillus in the other three. To minimize the incidence of
this often fatal disease, we have treated all patients in a laminar air flow room
since 1985, and no case of aspergillosis has developed since then. Candidiasis
appears to be difficult to diagnose, and our two cases of fatal candidiasis were
only suspected during the patients' lifetime. Only one patient received a short
course of amphotericin B, without evident result. Now that candidal antigens