HIGH-DOSE CARBOPLATIN, ETOPOSIDE AND MELPHALAN (CEM) WITH PERIPHERAL-BLOOD PROGENITOR-CELL SUPPORT AS LATE INTENSIFICATION FOR HIGH-RISK CANCER - NONHEMATOLOGICAL, HEMATOLOGICAL TOXICITIES AND ROLE OF GROWTH-FACTOR ADMINISTRATION

The present report describes the non-haematological toxicity and the i nfluence of growth factor administration on haematological toxicity an d haematopoietic recovery observed after high-dose carboplatin (1200 m g m(-2)), etoposide (900 mg m(-2)) and melphalan (100 mg m(-2)) (CEM) followed by peripheral blood progenitor cell transplantation (PBPCT) i n 40 patients with high-risk cancer during their first-line treatment. PBPCs were collected during the previous outpatient induction chemoth erapy programme by leukaphereses. CEM administration with PBPCT was as sociated with low non-haematological toxicity and the only significant toxicity consisted of a reversible grade III/IV increase in liver enz ymes in 32% of the patients. Haematopoietic recovery was very fast in all patients and the administration of granulocyte colony-stimulating factor (G-CSF) plus erythropoietin (EPO) or granulocyte-macrophage col ony-stimulating factor (GM-CSF) plus EPO after PBPCT significantly red uced haematological toxicity,abrogated antibiotic administration durin g neutropenia and significantly reduced hospital stay and patient's ho spital charge compared with patients treated with PBPCT only. None of the patients died early of CEM plus PBPCT-related complications. Low n on-haematological toxicity and accelerated haematopoietic recovery ren ders CEM with PBPC/growth factor support an acceptable therapeutic app roach in an adjuvant or neoadjuvant setting.