MYELO-ABLATIVE THERAPY WITH PERIPHERAL-BLOOD PROGENITOR-CELL (PBPC) SUPPORT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCY

Background: Myelo-ablative therapy with peripheral blood progenitor ce ll (PBPC) support is increasingly being used in patients with haematol ogical malignancy considered to be at high risk for recurrence. The re sults of this approach, in comparison with the previous experience at St. Bartholomew's Hospital (SBH) using autologous bone marrow transpla ntation form the basis of this report. Patients and methods: 42 patien ts (age range 18-63 years, median 42 years), deemed to have a poor pro gnosis-with conventional therapy received myelo-ablative therapy with PBPC support. Diagnoses comprised: non-Hodgkin's lymphoma (NHL): 16 pa tients, Hodgkin's disease (HD): 9, Multiple Myeloma (MM): 12, and soli d tumours (ST): 5. PBPC were mobilised using adriamycin: 35 mg/m(2) i. v. on day 1 and etoposide 100 mg/m(2) orally, days 1-5, followed by G- CSF: 5 mu g/kg, subcutaneously, for a median of 7 days (range 6-9 days ). Results: A total of 67 PBPC collections were performed, 1 being 'su fficient' (i.e. mononuclear cells greater than or equal to 1.5 x 10(8) /kg and CD34+ cells greater than or equal to 1 x 10(6)/kg) in 21 of th e 42 patients. The median time to haematological recovery following re infusion of PBPC was 13 days for both neutrophils >0.5 x 10(9)/l and p latelets >20 x 10(9)/l (ranges: 8-27, and 8-48 days, respectively) whi ch is significantly shorter than for patients in the historical contro l group. Supportive care requirements were also significantly reduced, as was the duration of hospital stay i.e., median 19 days (range 12-7 3 days) compared with 29 days (range 9-180 days). Conclusion: These re sults confirm rapid blood count recovery following myelo-ablative ther apy with PBPC support and the feasibility of this approach.