Autologous bone marrow/stem cell transplantation: Initial experience at a north Indian referral centre

Background. High-dose chemotherapy and/or radiation therapy rescued by auto logous bone marrow or peripheral blood stem cells is being increasingly use d for the treatment of haematological and solid malignancies. While few cen tres in India use this modality of therapy, the worldwide experience is enc ouraging. We, therefore, analysed the results of our initial experience wit h this therapeutic modality. Methods. Forty-two patients [multiple myeloma (17), Hodgkin's disease (4), non-Hodgkin's lymphoma (3), chronic myeloid leukaemia (2), acute myeloid le ukaemia (2), acute lymphoblastic leukaemia 12), epithelial ovarian cancer(6 ), breast cancer (4), primitive neuroectodermal tumour and testicular germ cell tumour(1 each)] underwent high-dose chemotherapy followed by either au tologous bone marrow transplant (n=9), peripheral blood stem cell transplan t (n=30) or both (n=3). The indications for transplant included either adva nced stage at diagnosis, other adverse prognostic indicators during the cou rse of their disease, or relapse. The data were analysed retrospectively in December 1998 using hospital records. Follow up data of all the patients w ere available. Results. Thirty-four of the 42 patients (81%) showed stable engraftment. Ei ght patients (19%) died in the early posttransplant period (day 5 to day 52 post-transplant). Seven patients died due to neutropenic infections and on e due to acute renal failure. Of the 34 surviving patients, 20 were alive a t the time of analysis and 1 4 had died. All but one death in this group we re due to progressive primary malignancy. The median overall survival for a ll patients was 17 months and for the 34 engrafted patients it was 27 month s. An analysis of factors affecting survival revealed that patients with ch emosensitive disease had a longer overall survival (20.9 v. 6.1 months, p=0 .04) compared to those with chemoresistant disease. Conclusion. Autologous bone marrow or peripheral stem cell transplantation is a feasible procedure in India with an acceptable morbidity and mortality . It should be offered more frequently to properly selected patients.