Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
CURRENT ADVANCES IN BMT FOR CANCER TREATMENT
Cancer Growth Prog; 10:165-79 1989. Unique Identifier : AIDSLINE ICDB/90660568 Kirkpatrick DV; Delmonte L; Dept. of Pediatrics, Tulane Univ. Medical Sch., New Orleans, LA; 70112
Abstract:
Bone marrow transplantation (BMT) is done to repopulate the hemopoietic and lymphoid systems following eradication of malignant cells with extremely high doses of chemotherapy (CT) or radiotherapy (RT) and, hopefully, to inhibit malignant progression. In the clinical situation, three types of BMT are possible: (1) autologous BMT, using the patient's (pt's) stored bone marrow; (2) syngeneic BMT, using identical-twin donor marrow; and (3) allogeneic BMT, using marrow from related or unrelated individuals. Donor and toxicity problems associated with allogeneic BMT have led to the exploration of autologous BMT as a viable alternative for allogeneic BMT; unfortunately, it is becoming increasingly apparent that the autologous approach may be less effective for achieving durable suppression of malignant disease. BMT is reviewed here under the following headings: graft-vs-host disease (GvHD); graft-versus-leukemia; secondary malignancies after BMT (including HIV infection and BMT); BMT for acute and chronic leukemias, hairy cell leukemia, solid tumors, hematologic tumors, and adult tumors; and autologous BMT for nonhematologic tumors. Current results support the use of BMT for hematologic malignancies, but the selection of appropriate pts for BMT remains a highly controversial area. In the younger pt, allogeneic BMT has been accepted as reasonable therapy for acute nonlymphocytic leukemia in complete remission (CR-1 and CR-2) and is now being established as the treatment of choice for acute lymphoblastic leukemia in CR-2 and non-Hodgkin's lymphoma (NHL) in CR-2. In older pts, the indication for allogeneic BMT is not as clear-cut. Early mortality associated with GvHD and interstitial pneumonia are problems with this approach. The elimination of the problem of GvHD and the marked reduction in interstitial pneumonia during the early post-transplant period with autologous BMT make it attractive for the older pt, but risk of relapse is increased. For tumors other than NHL, autologous BMT is being explored as a means of permitting delivery of very high doses of CT. Reports of 'good' responses are numerous, but few of the responses are complete, and duration of response generally is brief. Partial responders have residual disease, even after intensive CT/RT, and ultimately die of their disease despite BMT rescue for myelotoxicity. Finding appropriate CT agents and dosage schedules is the task of future studies. Until these regimens are found, indications for high-dose CT followed by autologous BMT remain unresolved. (155 Refs)
Keywords: Animal Bone Marrow Transplantation/*METHODS Combined Modality Therapy Dose-Response Relationship, Drug Follow-Up Studies Graft vs Host Disease/ETIOLOGY Human HIV Infections/ETIOLOGY Leukemia/DRUG THERAPY/RADIOTHERAPY/*THERAPY Neoplasms/DRUG THERAPY/RADIOTHERAPY/*THERAPY Neoplasms, Multiple Primary/ETIOLOGY Risk Factors JOURNAL ARTICLE REVIEW, TUTORIAL REVIEW 900530
M9051013
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
