NEW CONSECUTIVE HIGH-DOSE CHEMOTHERAPY MODALITY WITH FRACTIONATED BLOOD STEM-CELL SUPPORT IN THE TREATMENT OF HIGH-RISK PEDIATRIC SOLID TUMORS - A FEASIBILITY STUDY

Citation
T. Kajiume et al., NEW CONSECUTIVE HIGH-DOSE CHEMOTHERAPY MODALITY WITH FRACTIONATED BLOOD STEM-CELL SUPPORT IN THE TREATMENT OF HIGH-RISK PEDIATRIC SOLID TUMORS - A FEASIBILITY STUDY, Bone marrow transplantation, 21(2), 1998, pp. 147-151
Citations number
16
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Hematology,Oncology,Immunology,Transplantation
Journal title
ISSN journal
0268-3369
Volume
21
Issue
2
Year of publication
1998
Pages
147 - 151
Database
ISI
SICI code
0268-3369(1998)21:2<147:NCHCMW>2.0.ZU;2-3
Abstract
For the treatment of childhood solid tumors, we performed a pilot feas ibility study of consecutive high-dose therapies, in which each course was followed by transplantation with granulocyte colony-stimulating f actor-mobilized peripheral blood cells which had been separated into C D34-positive and -negative fractions by an Isolex system (Baxter), Pos itive selection of CD34(+) cells has been associated with inevitable c ell loss, To overcome this loss, CD34(+) cells that had migrated into the negative fraction were saved and used for the first transplant, wh ich was followed by a second transplant after a 3- to 5-month interval , In this phase I feasibility study, the results in six children were evaluated for safety and engraftment, Multi-drug cytoreductive regimen s using ranimustine (MCNU), melphalan, thiotepa, carboplatin, cyclopho sphamide or VP-16 were comparable between the two transplant procedure s in terms of their intensity. The number of CD34(+) cells in the 'CD3 4((+)) fraction' was 3.31 x 10(6)/kg (0.63-4.3 x 10(6)/kg), while this number in the 'CD34((-)) fraction' could not be evaluated correctly d ue their scarcity (< 0.1%). The median numbers of infused MNC and CFU- GM were, respectively, 4.2 x 10(6)/kg and 1.75 x 10(5)/kg in the CD34( +) fraction, and 4.8 x 10(8)/kg and 3.35 x 10(5)/kg in the CD34((-)) f raction, The number of days required to achieve an ANC > 0.5 x 10(9)/l and a platelet count > 20 x 10(9)/l and > 50 x 10(9)/l were, respecti vely, 14.5, 15.0 and 19.5 in the first transplant with CD34(-) cells, and 13.5, 18.0 and 25.0 in the second transplant with CD34(+) cells, w ith no essential difference between the two treatments, Although the s mall number of patients, the variation in clinical status and treatmen t, and the short follow-up invalidate any evaluation of the therapeuti c benefit of this strategy, the encouraging results support the feasib ility of this strategy, which enables an escalation of dose intensity with an improved cost/benefit ratio.