TREATMENT-RELATED MORTALITY IN 1000 CONSECUTIVE PATIENTS RECEIVING HIGH-DOSE CHEMOTHERAPY AND PERIPHERAL-BLOOD PROGENITOR-CELL TRANSPLANTATION IN COMMUNITY CANCER CENTERS

High-dose chemotherapy (HDC) with autologous peripheral blood progenit or cell (PBPC) is being increasingly utilized as a therapeutic modalit y for patients with chemotherapy-sensitive disease. Several published HDC regimens have become relatively widely used, The purpose of this a nalysis was to determine treatment-related mortality (TRM) following a dministration of five different HDC regimens in community cancer cente rs, A retrospective evaluation of 1000 consecutive patients with leuke mia, non-aodgkin's lymphoma, Hodgkin's disease, multiple myeloma, sarc oma, ovarian cancer, or breast cancer who received one of five publish ed HDC regimens followed by PBPC infusion over a 5-year period in comm unity cancer centers was performed to determine TRM. Fifty-nine patien ts (5.9%) died within 100 days of PBPC infusion, Twenty-five patients (2.5%) died predominantly of causes related to disease progression, Th irty-four patients (3.4%) died of TRM, 15 patients (1.5%) died from in fection and 19 (1.9%) died from regimen-related toxicities (RRT), In a logistic model, increasing age (P = 0.001) and lower numbers of CD34( +) cells/kg (P = 0.003) were associated with an increased risk of 100- day TRM. High-dose cyclophosphamide, thiotepa, and carboplatin was ass ociated with a lower risk of mortality than other regimens (P = 0.0001 ), High-dose chemotherapy and autologous PBPC support can be performed in community cancer centers with relative safety, Patient age, the ty pe of preparative regimen and the number of CD34(+) cells infused were important determinates of mortality.