Abstract
The antitumor effect of high-dose chemotherapy (HDC) followed by autologous peripheral blood stem cell transplantation (auto-PBSCT) is considered superior to that of conventional chemotherapy. However, the long-term benefits of this strategy in Japan remain unclear.Therefore, in this study, 109 cancer patients enrolled between 1989 and 1999 were treated with HDC and auto-PBSCT. Patients were evaluated for long-term survival and late-onset complications, including secondary malignancy. The mean number of CD34+ cells harvested per apheresis was larger in the group receiving high-dose cytosine arabinoside or high-dose etoposide plus granulocyte colony-stimulating factor (G-CSF) than in the group receiving conventional chemotherapy plus G-CSF. The 5-year overall survival rates for non-Hodgkin’s lymphoma patients in first complete remission (CR) (83.2%), second or subsequent CR (74.1%), or first partial remission (PR) (66.7%) at the time of transplantation were significantly higher than those with no remission (35.7%) at the time of transplantation (first CR,P < .05; second or subsequent CR,P < .05; first PR,P < .05). The 5-year overall survival (OS) rates for breast cancer was 40.8%, and the disease-free survival rate was extremely low (8.8%). The 5-year OS rates for chemotherapy-sensitive and chemotherapy-resistant diseases at the time of transplantation were 32.7% and 35.7%, respectively, a difference that was not considered significant. The 5-year OS for germ cell tumor was 80.0%, and the disease-free survival rate was 77.9%. The rate of therapy-related death was 8.2%. The occurrence rate of secondary malignancy was 0.9%. Late-onset complications were observed in 4 cases (glomerulonephritis, interstitial pneumonitis, ulcerative colitis, and acute myelogenous leukemia). At 3.7%, the occurrence rate was not very high, but most complications of auto-PBSCT were life threatening and interfered with patients’ quality of life. A careful follow-up is required for at least 2 years after transplantation, because the mean occurrence time of late-onset complications is 16.7 months posttransplantation.
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Majolino I, Pearce R, Taghipour G, Goldstone AH. Peripheral-blood stem-cell transplantation versus autologous bone marrow transplantation in Hodgkin’s and non-Hodgkin’s lymphomas: a new matched-pair analysis of the European Group for Blood and Marrow Transplantation Registry data.J Clin Oncol. 1997;15:509–517.
Shipp MA, Abeloff MD, Antman KH, et al. International Consensus Conference on High-Dose Therapy with Hematopoietic Stem Cell Transplantation in Aggressive Non-Hodgkin’s Lymphomas: report of the jury.J Clin Oncol. 1999;17:423–429.
Rutgers EG, Richel DJ, Baars JW, et al. Preliminary analysis of a randomized phase II study of high-dose chemotherapy in high-risk breast cancer [abstract].Eur J Cancer. 1996;32A:5.
Peters WP, Jones RB, Vredenburgh J, et al. A large, prospective, randomized trial of high-dose combination alkylating agents (CPB) with autologous cellular support (ABMS) as consolidation for patients with metastatic breast cancer achieving complete remission after intensive doxorubicin-based induction therapy (AFM).Proc Am Soc Clin Oncol. 1996;15:121–129.
Rahman ZU, Frye DK, Smith TL, et al. Results and long term follow-up for 1581 patients with metastatic breast carcinoma treated with standard dose doxorubicin-containing chemotherapy: a reference.Cancer. 1999;85:104–111.
Gianni AM, Bregni M, Siena S, et al. High dose chemotherapy and autologous bone marrow transplantation compared with MACOP-B in aggressive B-cell lymphoma.N Engl J Med. 1997;336:1290–1297.
Arriagada R, Le Chevalier T, Pignon JP, et al. Initial chemotherapeutic doses and survival in patients with limited small-cell lung cancer.N Engl J Med. 1993;329:1848–1852.
Makino S, Harada M, Akashi K, et al. A simplified method for cryopreservation of peripheral blood stem cells at −80 degrees C without rate-controlled freezing.Bone Marrow Transplant. 1991;8:239–244.
Chou T, Ishiguro T, Imajo K, et al. A multicenter early phase II study of high-dose chemotherapy with autologous peripheral blood stem cell transplantation for treatment of intermediate-grade non-Hodgkin’s lymphoma.Jpn J Clin Hematol. 1999;40:1058–1067.
Lotz JP, Machover D, Dalassagne B, et al. Phase I-II study of two consecutive courses of high-dose epipodophyllotoxin, ifosfamide, and carboplatin with autologous bone marrow transplantation for treatment of adult patients with solid tumors.J Clin Oncol. 1991;9:1860–1870.
Wilson WH, Jain V, Bryant G, et al. Phase I and II study of high-dose ifosfamide, calboplatin, and etoposide with autologous bone marrow rescue in lymphomas and solid tumors.J Clin Oncol. 1992;10:1712–1722.
Myers SE, Mick R, Williams SF. High-dose chemotherapy with autologous stem cell rescue in women with metastatic breast cancer with involved bone marrow: a role for peripheral blood progenitor transplant.Bone Marrow Transplant. 1994;13:449–454.
Kusnierz-Glaz CR, Schlegel PG, Wona RM, et al. Influence of age on the outcome of 500 autologous bone marrow transplant procedures for hematological malignancies.J Clin Oncol. 1997;15:18–25.
Andre M, Henry-Amar M, Blaise D, et al. Incidence of second cancers and causes of death after autologous stem cell transplantation for Hodgkin’s disease [abstract].Blood. 1995;86(suppl 1):640a.
To LB, Davy MLJ, Haylock DN, et al. Auto-transplantation using peripheral blood stem cells mobilized by cyclophosphamide.Bone Marrow Transplant. 1989;4:595–596.
Takaue Y, Hoshi Y, Watanabe T, et al. Collection and auto-grafts of peripheral blood stem cells in children with acute leukemias or non-Hodgkin’s lymphoma.Int J Cell Cloning. 1992;10(suppl 1): 152–154.
Gianni AM, Siena S, Bregni M, et al. Granulocyte-macrophage colony-stimulating factor to harvest circulating haemopoietic stem cells for auto-transplantation.Lancet. 1989;2:580–585.
Sheridan WP, Begley CG, Juttner CA, et al. Effect of peripheralblood progenitor cells mobilized by filgrastim (G-CSF) on platelet recovery after high-dose chemotherapy.Lancet. 1992;339:640–644.
Siena S, Bregni M, Brando B, et al. Circulation of CD34+, hematopoietic stem cells in the peripheral blood of high-dose cyclophosphamide-treated patients: enhancement by intravenous recombinant human granulocyte-macrophage colony-stimulating factor.Blood. 1989;74:1905–1914.
Shimazuki C, Oku N, Ashihara E, et al. Collection of peripheral blood stem cells mobilized by high-dose Ara-C plus VP-16 or aclarubicin followed by recombinant human granulocyte-colony stimulating factor.Bone Marrow Transplant. 1992;10:341–346.
A predictive model for aggressive non-Hodgkin’s lymphoma. The International Non-Hodgkin’s Lymphoma Prognostic Factor Project.N Engl J Med. 1993;329:987–994.
Haioun C, Lepage E, Gisselbrecht C, et al. Benefit of autologous bone marrow transplantation over sequential chemotherapy in poor risk aggressive non-Hodgkin’s lymphoma: update results of the prospective study LNH 87-2.J Clin Oncol. 1997;15:1131–1137.
Philip T, Guglielmi C, Hagenbeek A, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin’s lymphoma.N Engl J Med. 1995;333:1540–1545.
Nademanee A, Molina A, O’Donnell MR, et al. Results of high-dose therapy and autologous bone marrow/stem cell transplantation during remission in poor-risk intermediate and high-grade lymphoma: international index high and high-intermediate risk group.Blood. 1997;90:3844–3852.
Peter WP, Ross M, Vredenburg JJ, et al. High-dose chemotherapy and autologous bone marrow support as consolidation after standard-dose adjuvant therapy for high-risk breast cancer.J Clin Oncol. 1993;11:1132–1143.
Rodenhuis SR, Richel DJ, van der Wall E, et al. Randomized trial of high-dose chemotherapy and haemopoietic progenitor-cell support in operable breast cancer with extensive axillary lymph-node involvement.Lancet. 1998;352:51–52.
Long GD, Negrin RS, Hoyle CF, et al. Multiple cycles of high dose chemotherapy supported by hematopoietic progenitor cells as treatment for patients with advanced malignancies.Cancer. 1995;76:860–868.
Stone RM, Neuberg D, Soffier R, et al. Myelodysplastic syndrome as a late complication following autologous bone marrow transplantation for non-Hodgkin’s lymphoma.J Clin Oncol. 1994;12:2535–2543.
Darrington DL, Vose JM, Anderson FR, et al. Incidence and characterization of secondary myelodysplastic syndrome and acute myelogenous leukemia following high-dose chemoradiotherapy and autologous stem cell transplantation for lymphoid malignancies.J Clin Oncol. 1994;12:2527–2534.
Anonymous:WHO Handbook for Reporting Results of Cancer Treatment. Geneva: World Health Organization;1979:14–21.
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Kohda, K., Sakamaki, S., Matsunaga, T. et al. Long-Term Survival and Late-Onset Complications of Cancer Patients Treated With High-Dose Chemotherapy Followed by Autologous Peripheral Blood Stem Cell Transplantation. Int J Hematol 73, 251–257 (2001). https://doi.org/10.1007/BF02981946
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DOI: https://doi.org/10.1007/BF02981946