Autologous Stem Cell Transplantation

Biological and Clinical Results in Malignancies

Angelo Carella

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000141320
• Edition: 1
• Topic: Medicine
• Subtopic: Surgery & Surgical Medicine

This textbook integrates basic research and clinical aspects underlying the most recent results in those malignant diseases where progress is most effective.
Recent evidence shows that higher doses are better in inducing higher cure rates in hematological neoplasias, although myeloblation related to dose intensity can be a limiting factor. The toxicity can now be controlled with autologous marrow and peripheral blood progenitor cell transplantation, used with or without growth factors. The combination of high dose chemoradiotherapy followed by re-infusion of autologous stem cells constitute a dramatic advance in the treatment of refactory and relapse hematological neoplasias.

1 AUTOTRANSPLANT ACTIVITY 1989–1994

R.P. GALE, PA. ROWLINGS and J.O. ARMITAGE

Autologous Blood & Marrow Transplant Registry — North America, Health Policy Institute, Medical College of Wisconsin, Milwaukee, USA; Division of Bone Marrow and Stem Cell Transplantation, Salick Health Care, Inc., Los Angeles, USA; and the University of Nebraska Medical Center, Omaha, USA

Auto transplants are increasingly used to treat cancer. In 1989 the National Institutes of Health of the United States began support of the Autologous Blood & Marrow Transplant Registry (ABMTR) to study outcomes of autotransplants. The ABMTR is a voluntary scientific organization of more than 130 auto transplant centers in the US, Canada, South America, Russia, Cuba and Austria. Distribution of centers and registered cases is indicated in Table 1.

The ABMTR registers all consecutive autotransplants at participating centers. More detailed reporting is requested in specific diseases. Presently these are breast cancer, lymphomas and acute myelogenous and lymphoblastic leukemias (AML, ALL). Detailed reporting will begin soon for multiple myeloma.

The more than 14,000 autotransplants done between January 1989 and June 1994 at participating centers are summarized in Figure 1 and Table 2. Most autotransplants (N = 5845) were for lymphomas (non-Hodgkin, N = 3708; Hodgkin, N = 2137), breast cancer (N = 4004), acute myelogenous leukemia (N = 1433) and multiple myeloma (N = 610). A detailed description is presented in Table 2. We estimate that these include about 50% of all autotransplants done in North America during this time period.

Table 3 describes the more than 3000 cases reported in detail to the ABMTR during this interval including breast cancer (N = 1346), lymphomas (N = 1134; non-Hodgkin, N = 739; Hodgkin, N = 395) and leukemia (N = 780; AML, N = 600; ALL, N = 180).

Table 1 Geographic distribution of registering teams and registered patients

Geographic Area	Registering Teams	Registered Patients
United States	117	13531 (88%)
Canada	18	1312 (9%)
South America	4	322 (2%)
Other	3	109 (1%)
TOTAL	142	15274

Table 2 Distribution of auto transplants performed between 1989 and 1994 and registered with the ABMTR by 142 teams

Figure 1 Auto transplants registered with ABMTR, 1989–94

Table 3 Auto transplants reported 1989–1994^a

Acute myelogenous leukemia	600
Acute lymphoblastic leukemia	180
Non-Hodgkin lymphoma	739
Hodgkin disease	395
Breast cancer	1346
TOTAL	3260

^aComprehensive clinical data available for all cases.

These data indicate increasing use of autotransplants in cancer. Future ABMTR studies will consider variables associated with transplant outcome, compare results of auto- and allotransplants and compare autotransplant outcome with other therapies.

Supported by Public Health Service Grant No. PO1-CA-40053 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Heart, Lung and Blood Institute of the U.S. Department of Health and Human Services; the U.S. Army Medical Research and Development Command; and by grants from Amgen Inc.; Astra Pharmaceutical Products; Baxter Healthcare Corporation; Bristol-Myers Oncology; Caremark, Inc.; CellPro, Inc.; Center for Advanced Studies in Leukemia; COBE BCT, Inc.; Glaxo Pharmaceutical; Hewlett-Packard Company; Immunex Corporation; Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation; Lederle Laboratories; Marion Merrell Dow Inc.; Milstein Family Foundation; Milwaukee Foundation/Elsa Schoeneich Research Fund; Ortho Biotech, Inc.; Pharmacia; Quadra Logic Technologies; Roerig/Pfizer Pharmaceuticals; Sandoz Oncology; StemCell Technologies; SyStemix; and Upjohn Company.

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Introduction to the Series
• Preface
• Foreword
• 1 Autotransplant Activity 1989–1994
• 2 Purification and Evaluation of Hematopoietic Stem Cells for Transplantation
• 3 Cytokine Regulation of Primitive Progenitors in Culture
• 4 Isolation of both Normal and Leukemic Cells within the Hematopoietic Stem Cell Compartment of Chronic Myelogenous Leukemia Mobilized Peripheral Blood
• 5 Expansion and Clinical Use of Hematopoietic Progenitor Cells in Human Marrow and Peripheral Blood
• 6 Theoretical Basis for Autografting
• 7 Pattern of Reconstitution and Relapse following Autologous Bone Marrow Transplantation for Chronic Myelogenous Leukemia
• 8 Harnessing Immune Control of Leukemia in Autografting
• 9 Pharmacology of High-Dose Therapy with Bone Marrow Transplantation
• 10 The Detection of Minimal Residual Disease in Acute Leukemia
• 11 Marrow Contamination: Detection and Significance
• 12 Marrow Contamination: Pharmacological Treatment
• 13 Marrow Contamination: Immunological Treatment
• 14 Hemopoietic Growth Factors and Autografting
• 15 Autologous Graft-versus-Host Disease
• 16 Approaches to Improving the Results of Total Body Irradiation in Marrow Transplantation
• 17 Pretransplant Regimens without Total Body Irradiation (TBI)
• 18 New Pre-transplant Regimens
• 19 How does Autologous Hemopoietic Cell Transplantation Cure Acute Myeloid Leukemia?
• 20 Treatment of Acute Lymphoblastic Leukemia (ALL) in Adults: Problems and Pitfalls
• 21 Autologous Stem Cell Transplantation for Acute Lymphoblastic Leukemia in Children
• 22 Autologous Bone Marrow Transplantation for Acute Lymphoblastic Leukemia in Adults
• 23 Treatment of Acute Myloid Leukemia: State of the Art
• 24 The Present Status of Autologous Bone Marrow Transplantation in Acute Myeloid Leukaemia
• 25 Minimal Residual Disease in Leukemia
• 26 Autografting for Chronic Myelogenous Leukemia: Is there a Role?
• 27 Autografting with Cultured Marrow for the Myeloid Leukemias: The Vancouver Experience
• 28 In Vivo Mobilization of Ph1 - Negative Peripheral Blood Progenitor Cells and Autografting in Chronic Myelogenous Leukemia: The Genoa Experience
• 29 How does Autografting Cure Aggressive Malignant Non-Hodgkin’s Lymphoma?
• 30 The Role of Autografting in Low-grade Lymphoma
• 31 Autologous Stem Cell Transplantation in Intermediate and High Grade Lymphoma
• 32 Autografting for Lymphoblastic Lymphoma
• 33 High Dose Therapy (HDT) in Burkitt’s Lymphoma
• 34 Autografting for Hodgkin’s Disease
• 35 The Role of Intensive Therapy and Autotransplantation for Hodgkin’s Disease Patients in an Initial Complete or Partial Remission
• 36 Autologous Transplants for Multiple Myeloma
• 37 Autografting in Breast Cancer
• 38 High Dose Chemotherapy with Stem Cell Support for Miscellaneous Solid Tumors
• 39 High-Dose Therapy followed by Bone Marrow Rescue in Pediatric Solid Tumors
• 40 Autografting with Blood Stem Cell in Hematological Neoplasias: Review of Indications
• 41 Umbilical Cord Biology and Transplant
• 42 Immunotherapy by Allogeneic Lymphocytes and Cytokines following Autologous and Allogeneic Bone Marrow Stem Cell Transplantation
• 43 Immune Ablation Followed by Stem Cell Transplantation (Allogeneic) or Support (Autologous) for Severe Autoimmune Diseases Progress, Controversies and Suggested Guidelines
• Index