HIGH-DOSE CHEMOTHERAPY WITH STEM-CELL REINFUSION AND GROWTH-FACTOR SUPPORT FOR SOLID TUMORS

With the help of stem cell reinfusion and hematopoietic growth factors , it is possible to get up to a ten-fold dose increase for certain che motherapeutic drugs, A number of reasons may have made high-dose chemo therapy less dangerous and the fore more acceptable in a more upfront treatment setting, One of these is the addition of peripheral stem cel l harvest obtained after mobilization,vith a hematopoietic growth fact or alone or after chemotherapy followed by a hematopoietic growth fact or, which seems to result in a faster recovery of neutrophils and plat elets compared to bone marrow reinfusion alone, The combination of var ious hematopoietic growth factors could potentially improve hematopoie tic recovery of the high-dose chemotherapy regimen, The relevance of t umor cells sometimes present in the reinfused hematopoietic stem cells is as yet unknown. High-dose chemotherapy may be interesting for a nu mber of solid tumors such as nonseminomatous testicular carcinoma, bre ast carcinoma in the metastatic and adjuvant setting, ovarian carcinom a, tumors of young adults such as Ewing sarcoma and small cell lung ca rcinoma, In patients with refractory nonseminomatous testicular cancer there have been a number of studies performed with high-dose chemothe rapy showing a 15% complete and prolonged remission, For other tumor t ypes and settings it will be necessary to perform randomized studies b efore firm conclusions can be drawn, For example, this is especially i mportant for patients with breast carcinoma with more than three posit ive axillary lymph nodes, Preliminary data from various groups compare d to historical controls treated with standard adjuvant chemotherapy s how favorable results of adjuvant chemotherapy containing high-dose ch emotherapy, Many relatively small nonrandomized studies are performed in various stages of disease for ovarian carcinoma, Although there are long-term survivors reported it is currently difficult to draw firm c onclusions, The potentially safer therapy of high-dose chemotherapy ma y reveal in the near future the role of high-dose chemotherapy in soli d tumors.