No abstract

Summary:The purpose of the study was to evaluate the effect of delayed granulocyte colony-stimulating factor (G-CSF) use on hematopoietic recovery post-autologous peripheral blood progenitor cell (PBPC) transplantation. Patients were randomized to begin G-CSF on day +1 or day +7 post transplantation. Thirty-seven patients with lymphoma or myeloma undergoing high-dose therapy and autologous PBPC rescue were randomized to daily subcutaneous G-CSF beginning on day +1 or day +7 post-transplant. Patients р70 kg received 300 g/day and Ͼ70 kg 480 g/day. All patients were reinfused with PBPCs with a CD34 + cell count Ͼ2.0 × 10 6 /kg. Baseline characteristics of age, sex and CD34 + cell count were similar between the two arms, the median CD34 + cell count being 5.87 × 10 6 /kg in the day +1 group and 7.70 × 10 6 /kg in the day +7 group (P = 0.7). The median time to reach a neutrophil count of Ͼ0.5 × 10 9 /l was 9 days in the day +1 arm and 10 days in the day +7 arm, a difference which was not statistically significant (P = 0.68). Similarly, there was no difference in median days to platelet recovery Ͼ20 000 × 10 9 /l, which was 10 days in the day +1 arm and 11 days in the day +7 arm (P = 0.83). There was also no significant difference in the median duration of febrile neutropenia (4 vs 6 days; P = 0.7), intravenous antibiotic use (7 vs 8 days; P = 0.54) or median number of red blood cell transfusions (4 vs 7 units; P = 0.82) between the two arms. Median length of hospital stay was 11 days post-PBPC reinfusion in both groups. The median number of G-CSF injections used was 8 in the day +1 group and 3 in the day +7 group (P Ͻ 0.0001). There is no significant difference in time to neutrophil or platelet recovery when G-CSF is initiated on day +7 compared to day +1 post-autologous PBPC transplantation. There is also no difference in number of febrile neutropenic or antibiotic days, number of red blood cell transfusions or length of hospital stay. The number of doses of G-CSF used per transplant is significantly reduced with delayed initiation, resulting in a significant reduction in drug

Total-body irradiation (nn) is a therapy modality that is being used wilh inaeasing kquency, in conjunction wilh chemotherapy, for patients undergoing b o n e -m o w transplantation. At the Ottawa Regional Cancer centre a technique has been developed for the delivery of ~B Ito patients prior to bo~marrow transplantation. In this technique pakients are treafed on a mobile couch at approximately 195 cm SSD with a field size of 66.5 cm wide by 57 cm long. A computersontrolled stepping motor drives the patient couch at a user-selectable speed. The total dose delivered to the patient is a function of couch velocity, field size and patient separation. T"II times are of Le order of 10 min for each of the anterior and posterior fields for a 400 ffiy fraclion. It has been found that Le wnventional m k a l axis tissue maximum ntio (m) and percentage depth dose (PDD) functions are not appropiiate for describing dose delivered during dynamic t"er!l.To this end we have developed dynamic m and EUD functions. Extensive measurements have been performed in an anthropomorphic water phantom to detemine the dose dishibutions in three dimensions and the efficacy of polymethyl methacrylate (PU) bean spoilers as a replacement for anterior and lateral bolus.It has been found that 2.4 cm PMMA spoilers do provide full skin dose and negate the requirement for laled bolus. This 181 procedure is simple, rapid and appears to be well tolerated by the paIients. 55 patients have been hated since the i n m d d o n of this technique in 1991.

Autologous stem cell transplant (ASCT) has been shown to be an effective treatment for follicular lymphoma (FL). We explored our experience in ASCT for FL among all patients treated over a 15-year period from diagnosis through their entire treatment history including relapse post ASCT. All patients who underwent an unpurged ASCT for relapsed, advanced FL between June 1990 and December 2000 were analyzed. After salvage therapy they received melphalan/etoposide/total body irradiation, BCNU, etoposide, cytarabine, melphalan (BEAM), or cyclophosphamide BCNU etoposide (CBV) as conditioning for the ASCT. One hundred thirty-eight patients with a median age of 48 years and a median follow-up of 7.6 years were analyzed. The majority were of the subtype grade 1, nontransformed (FL-NT), having had 1 prior chemotherapy. The progression-free (PFS) and overall survival (OS) of the FL-NT at 10 years were 46% and 57%, respectively, and at 5 years for the transformed (FL-T) were 25% and 56%, respectively, of which only the PFS was significantly different (P=.007). The median OS from diagnosis was 16 years for the FL-NT. ASCT positively altered the trend of shorter remissions with subsequent chemotherapies, and there was no difference in OS between those who had 1, 2, or >2 chemotherapies prior to ASCT. Salvage therapy for relapse post ASCT was effective (OS>1 year) in a third of patients. Unpurged ASCT is an effective tool in the treatment of relapsed, aggressive FL-NT and FL-T, is superior to retreatment with standard chemotherapy, is effective at various stages of treatment, is likely to have a beneficial influence on the natural history of this disease, and the disease is amenable to salvage therapy post-ASCT relapse.