Skip to main content

Advertisement

SpringerLink
Log in

Conditioning Regimens in Autologous Bone Marrow Transplantation

  • Practical Therapeutics
  • Published:
Clinical Immunotherapeutics Aims and scope Submit manuscript

Summary

In the past decade, the practice of autologous bone marrow transplantation has become widespread, and is now the most commonly performed type of bone marrow transplantation. Recent advances using recombinant haemopoietic growth factors and autologous peripheral stem cells are likely to further reduce the morbidity and mortality of this procedure.

We have analysed the currently available conditioning regimens for autologous bone marrow transplantation, and were unable to observe significant differences in disease-free survival and cure rates. It seems likely that current chemoradiotherapeutic conditioning regimens are at the limit of multiorgan toxicity. Moreover, because the relationship between the dosage of chemoradiotherapy and the resulting tumouricidal effect is logarithmic, substantial increments of chemoradiotherapy might be needed for total eradication of malignancy and therefore cure.

To achieve optimal cure rates, alternative approaches such as cell-mediated or cytokine-mediated immunotherapy may be needed in order to control residual clonogenic tumour cells that have escaped chemoradiotherapeutic conditioning regimens.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Champlin R. Preparative regimens for autologous BMT. Blood 1993; 81: 277–80

    PubMed  CAS  Google Scholar 

  2. Simone JV. ABMT in childhood cancer. J Clin Oncol 1993; 11: 1439–40

    PubMed  CAS  Google Scholar 

  3. Ariad S, Geffen D. Role of colony-stimulating factors during high dosage chemotherapy. Clin Immunother 1994; 1: 449–59

    Article  Google Scholar 

  4. Stuart RK. ABMT for leukemia. Semin Oncol 1993; 20 (4 Suppl.): 40–54

    PubMed  CAS  Google Scholar 

  5. Carella AM, Frassoni F, Van Lint MT, et al. Autologous and allogenic BMT in AML in first complete remission: an update of the Genoa experience with 159 patients. Ann Hematol 1992; 62: 128–31

    Article  Google Scholar 

  6. Cassileth PA, Andersen J, Lazarus HM, et al. Autologous bone marrow transplant in AML in first remission. J Clin Oncol 1993; 11: 314–9

    PubMed  CAS  Google Scholar 

  7. Sullivan KM, Deeg HJ, Saunders JE, et al. Late complications after marrow transplantation. Semin Hematol 1984; 21: 53–63

    PubMed  CAS  Google Scholar 

  8. Dinsmore R, Kirpatrick D, Flomenberg N, et al. Allogeneic BMT for patients with acute non-lymphocytic leukaemia. Blood 1984; 63: 649–56

    PubMed  CAS  Google Scholar 

  9. Appelbaum FR. The influence of total dose, fractionation and distribution of total body irradiation on BMT. Semin Oncol 1993; 4 Suppl. 4: 3–10

    Google Scholar 

  10. Santos GW. The development of busulfan/cyclophosphamide preparative regimen. Semin Oncol 1993; 20 (4 Suppl.): 12–6

    PubMed  CAS  Google Scholar 

  11. Linker CA, Ries CA, Danon HS, et al. Autologous BMT for acute myeloid leukaemia using busulfan plus etoposide as a preparative regimen. Blood 1993; 81: 311–8

    PubMed  CAS  Google Scholar 

  12. Vaughan WP, Dennison JD, Reed ED, et al. Improved results of ABMT for advanced hematologic malignancy using busulfan, cyclophosphamide and etoposide as cytoreductive and immunosuppressive therapy. Bone Marrow Transplant 1991; 8: 489–95

    PubMed  CAS  Google Scholar 

  13. Geller LB, Myers S, Devine S, et al. Phase I study of busulfan, cyclophosphamide and timed sequential escalating doses of cytarabine followed by bone marrow transplantation. Bone Marrow Transplant 1992; 9: 41–7

    PubMed  CAS  Google Scholar 

  14. Grochow LB, Krivit W, Whitley BC, et al. Busulfan disposition in children. Blood 1990; 75: 1723–7

    PubMed  CAS  Google Scholar 

  15. Wolf SM, Herzig R, Fay JW, et al. High-dose thiotepa with autologous BMT — phase I studies. Semin Oncol 1990; 17 (3 Suppl.): 2–11

    Google Scholar 

  16. Gorin NC, Labopin N, Meloni G, et al. Autologous BMT for AML in Europe: further evidence of the role of marrow purging by mafosfamide. Leukemia 1991; 5: 896–901

    PubMed  CAS  Google Scholar 

  17. Armitage JO. Application of ABMT to the treatment of cancer. Curr Opin Hematol 1993; 1: 240–5

    Google Scholar 

  18. Sallan SE, Niemeyer CM, Billett AL, et al. ABMT for ALL. J Clin Oncol 1989; 7: 1594–601

    PubMed  CAS  Google Scholar 

  19. Schroder H, Pinkerton CR, Powles RL, et al. High-dose melphalan and TBI with autologous bone marrow rescue in childhood ALL after relapse. Bone Marrow Transplant 1991; 7: 11–5

    Google Scholar 

  20. Doney K, Buckner CD, Fischer L, et al. Autologous BMT for acute lymphoblastic leukemia. Bone Marrow Transplant 1993; 12: 315–21

    PubMed  CAS  Google Scholar 

  21. Uckun FM, Kersey JH, Vallera DA, et al. Autologous BMT in high-risk remission T-lineage ALL using immunotoxins plus 4-hydroperoxycyclophosphamide for marrow purging. Blood 1990; 76: 1723–33

    PubMed  CAS  Google Scholar 

  22. Higuchi CM, Thompson JA, Petersen HG, et al. Toxicity and immunomodulatory effects of interleukin-2 after ABMT for hematologic malignancies. Blood 1991; 77: 2561–668

    PubMed  CAS  Google Scholar 

  23. Oleksowicz L, Sparano J, O’Boyle K, et al. Interleukins in cancer therapy. Clin Immunother 1994; 1: 271–81

    Article  Google Scholar 

  24. Daley GQ, Goldman JM. Autologous transplant for CML revisited. Exp Hematol 1993; 21: 734–7

    PubMed  CAS  Google Scholar 

  25. Carella A, Gaozza E, Raffo MR, et al. Therapy of acute phase CML with intensive chemotherapy, blood cell autograft and cyclosporine A. Leukemia 1991; 5: 517–21

    PubMed  CAS  Google Scholar 

  26. Reiffers J, Trouette R, Marit G, et al. Autologous blood stem cell transplantation for CML in transformation: a report of 47 cases. Br J Haematol 1991; 77: 339–45

    Article  PubMed  CAS  Google Scholar 

  27. McMillan AK, Goldstone AH. Autologous bone marrow transplantation non-Hodgkin’s lymphoma. Eur J Haematol 1991; 46: 129–35

    Article  PubMed  CAS  Google Scholar 

  28. Vose JM, Armitage JO. Role of ABMT in non-Hodgkin’s lymphoma. Autologous bone marrow transplantation. Hematol Oncol Clin North Am 1993; 7: 577–90

    PubMed  CAS  Google Scholar 

  29. Freedman AS, Takvorian T, Neuberg D, et al. Autologous BMT in poor-prognosis intermediate-grade and high-grade B-cell non-Hodgkin’s lymphoma in first remission: a pilot study. J Clin Oncol 1993; 11: 931–6

    PubMed  CAS  Google Scholar 

  30. Freedman A, Nadler LM. BMT in low-grade non-Hodgkin’s lymphoma. Marrow Transplant Rev 1992; 2: 33–4

    Google Scholar 

  31. Philip T, Armitage JO, Spitzer G, et al. High-dose therapy and ABMT after failure of conventional chemotherapy in adults with intermediate-grade or high-grade non-Hodgkin’s lymphoma. N Engl J Med 1987; 316: 1493–9

    Article  PubMed  CAS  Google Scholar 

  32. Coiffier B, Gisselbrecht C, Vose JM, et al. Prognostic factors in aggressive malignant lymphomas. J Clin Oncol 1991; 9: 211–8

    PubMed  CAS  Google Scholar 

  33. Bearman SI, Appelbaum FR, Back A, et al. Regimen-related toxicity and early post-transplant survival in patients undergoing marrow transplantation for lymphoma. J Clin Oncol 1989; 7: 1288–94

    PubMed  CAS  Google Scholar 

  34. Crilley P, Lazarus H, Topolsky D, et al. Comparison of preparative transplantation regimens using carmustine/etoposide/cisplatine or busulfan/etoposide/cyclophosphamide in lymphoid malignancies. Semin Oncol 1993; 20 (4 Suppl.): 50–4

    PubMed  CAS  Google Scholar 

  35. Srivastava A, Bradstock KF, Szer J, et al. Busulfan and melphalan prior to autologous BMT. Bone Marrow Transplant 1993; 12: 323–9

    PubMed  CAS  Google Scholar 

  36. Chopra R, McMillan AK, Linch DC, et al. The place of high-dose BEAM therapy and ABMT in poor-risk Hodgkin’s disease: a single-center eight-year study of 155 patients. Blood 1993; 81: 1137–45

    PubMed  CAS  Google Scholar 

  37. Gordon BG, Warkertin PI, Weisenburger DD, et al. BMT for peripheral T-cell lymphoma in children and adolescents. Blood 1992; 80: 2938–42

    PubMed  CAS  Google Scholar 

  38. Morecki S, Ravel-Vilk S, Nagler A, et al. Immunological evaluation of patients with hematological malignancies receiving ambulatory cytokine-mediated immunotherapy with recombinant human interferon-alfa2a and interleukin-2. Cancer Immunol Immunother 1992; 35: 401–11

    Article  PubMed  CAS  Google Scholar 

  39. Klapholcz L, Ackerstein A, Nagler A, et al. Local cutaneous reaction induced by subcutaneous interleukin-2 and interferon alpha-2a immunotherapy following ABMT. Bone Marrow Transplant 1993; 11: 443–6

    Google Scholar 

  40. Schechter D, Nagler A, Ackerstein A, et al. Recombinant interleukin-2 and interferon alpha immunotherapy following ABMT: a case report of cardiovascular toxicity with serial echocardiographic evaluation. Cardiology 1992; 80: 168–71

    Article  PubMed  CAS  Google Scholar 

  41. Vose JM, Bierman PJ, Armitage JO. Hodgkin’s disease: the role of bone marrow transplantation. Semin Oncol 1990; 17: 749–57

    PubMed  CAS  Google Scholar 

  42. Desh CE, Lasala MR, Smith TJ, et al. The optimal timing of ABMT in Hodgkin’s disease patients after a chemotherapy relapse. J Clin Oncol 1992; 10: 200–9

    Google Scholar 

  43. Carella AM, Carlier P, Congiu A, et al. Autologous BMT as adjuvant treatment for high-risk Hodgkin’s disease in first complete remission after MOPP/ABVD protocol. Bone Marrow Transplant 1991; 8: 99–103

    PubMed  CAS  Google Scholar 

  44. Miller JS, Arthur DC, Litz CE, et al. Myelodysplasic syndrome following ABMT: an additional late complication of curative cancer therapy. Blood 1993; 82 (1 Suppl.): 455a

    Google Scholar 

  45. Chao NJ, Nademanee AP, Long GD, et al. Importance of bone marrow cytogenetic evaluation before ABMT for Hodgkin’s disease. J Clin Oncol 1991; 9: 1575–9

    PubMed  CAS  Google Scholar 

  46. Alexanian R, Dimopoulos MA. The treatment of multiple myeloma. N Engl J Med 1994; 330: 484–9

    Article  PubMed  CAS  Google Scholar 

  47. Barlogie B, Gahrton G. Bone marrow transplantation in multiple myeloma — a review. Bone Marrow Transplant 1991; 7: 71–9

    PubMed  CAS  Google Scholar 

  48. Dimopoulos MA, Alexanian R, Przepiorka D, et al. Thiotepa, busulfan, and cyclophosphamide: a new preparative regimen for autologous blood stem cell transplantation in high-risk multiple myeloma. Blood 1993; 82: 2324–8

    PubMed  CAS  Google Scholar 

  49. Anderson KC, Barut BA, Ritz J, et al. Monoclonal antibody-purged ABMT therapy for multiple myeloma. Blood 1991; 77: 712–20

    PubMed  CAS  Google Scholar 

  50. Attal M, Huguet F, Schlaifer D, et al. Maintenance treatment with rh-alfa-interferon after autologous BMT for aggressive myeloma in first remission after conventional induction chemotherapy. Bone Marrow Transplant 1991; 8: 125–8

    PubMed  CAS  Google Scholar 

  51. Peters WP, Ross M, Vredenburgh J, et al. High-dose alkylating agents and ABMT for stage II/III breast cancer involving 10 or more axillary lymph nodes. Proc Am Soc Clin Oncol 1992; 11: 58–65

    Google Scholar 

  52. Vaugham WP. Autologous BMT in the treatment of breast cancer. Semin Oncol 1993; 20 (6 Suppl.): 55–8

    Google Scholar 

  53. Meyers SE, Williams SF. Role of high dose chemotherapy and autologous stem cell support in treatment of breast cancer. Hematol Oncol Clin North Am 1993; 7: 631–45

    Google Scholar 

  54. Kennedy MJ. Induction of graft-versus-host syndrome as a treatment for breast cancer. Clin Immunother 1994; 1: 173–80

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Bone Marrow Transplantation, Hadassah University Hospital, Jerusalem, 91120, Israel

    Gabor Varadi &  Arnon Nagler

Authors
  1. Gabor Varadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arnon Nagler
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Varadi, G., Nagler, A. Conditioning Regimens in Autologous Bone Marrow Transplantation. Clin. Immunother. 2, 342–351 (1994). https://doi.org/10.1007/BF03259494

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03259494

Keywords

Search

Navigation