Autologous Bone Marrow Transplantation - Blog Science Connections

Toxic Deaths in ABMT 63 7
Patient/
Age/Sex
Table 3. Deaths After Recovery From Granulocytopenia
Diagnosis
Status
Before
ABMT
Status
at
Death
Delay of
Death/ABMT
(days)
Principal
Cause of
Death
Other
Events
1/28/M Lymphoma SR CR 32 Aspergillosis CNS
bleeding
2/16/F Lymphoma SR CR 44 VOD CNS
bleeding
3/1/M
CR CR 32 CNS bleeding Pneumonia
4/26/M Ewing's tumor RR PR 44 Candidiasis
5/3/M Neuroblastoma CR CR 36 VOD CNS
bleeding
6/39/M Lung cancer SR PR 31 VOD CNS
bleeding
7/19/F Soft tissue
sarcoma
SR CR 36 Aspergillosis CNS
bleeding
8/30/M Germinal tumor RR PR 37 Viral pneumonia
9/1/M
Medulloblastoma
Medulloblastoma
SR CR 62 Sudden death
unexplained
Abbreviations: ABMT, autologous bone marrow transplantation; CR, complete
remission; PR, partial response; SR, sensitive relapse; RR, resistant relapse; VOD,
veno-occlusive disease; CNS, central nervous system.
We now consider deaths of noninfectious origin to be the major problem.
Since 1985 we have observed only eight toxic deaths after 77 courses of
ABMT, and six of the eight were of noninfectious origin. Cyclophosphamide
cardiomyopathy occurred in two high-risk patients. One had received
previous thoracic irradiation and a high cumulative dose of Adriamycin
(doxorubicin); the other developed atheromatous coronaropathy. The
complication was always fatal. VOD was responsible for the deaths of three
patients in CR. No treatment was efficient in the acute phase of the VOD (five
patients). Portacaval shunt or hepatic transplantation, which has been
proposed for subacute VOD (7), was not considered for the acute phase.
Preventive therapies have never been assessed, except in animals, but
heparin seems to be a possible preventive agent against the damage of
hepatic irradiation (8). We plan to evaluate in a randomized study the possible
advantage of heparin administered during conditioning regimens as a
preventive agent of VOD.
We can conclude that 1) the risk of toxic death is higher for patients in RR,
but it is present for patients in SR or CR or responsive to the conditioning
regimen; 13 of 28 toxic deaths occurred during CR in our study; 2) a well-