HIGH-DOSE CHEMOTHERAPY AND PERIPHERAL-BLO OD PROGENITOR CELLS WITH RESPECT TO SOLID TUMORS

High-dose chemotherapy is a policy which is increasing in the field of solid tumors both in Europe and in North America. Hundreds of patient s undergo ABMT or PBPCT in Europe every year especially for breast car cinoma. Waiting for the results several ongoing trials, high-dose chem otherapy has shown to be of extreme Interest in the adjuvant setting o f patients with high risk breast cancer in phase II trials. The best r esults had been reported by Peters and Gianni; with a minimum follow-u p of 5 years 65 and 56% of their patients with ten or more axillary ly mphnodes are alive disease free. These results are better than any oth ers with standard doses, The only one published trial (from South Afri ca) on advanced disease clearly favours high-doses of cyclophosphamide , mitoxantrone and etoposide versus standard doses of cyclophosphamide , mitoxantrone and vincristine in terms of overall survival and time t o relapse. The use of PBPC replacing ABMT has allowed an easier tolera bility of the procedure and a reduction of the costs. There is a clear reduction of the toxic death rate to 1% in 1995 for breast cancer pat ients compared with 20% of fifteen years ago. Germ cell tumors in resp onding relapse after salvage chemotherapy seem to be ideal candidates for ABMT/PBPC programs with an expected 40% disease free survival. The clinical impact of the PBPC contamination by tumor cells is still now adays a matter of debate at least for breast carcinoma and neuroblasto ma. This review will focus on the present situation of high-dose chemo therapy for solid tumors with some insights to new technologies and th eir applications.