Autologous stem cell transplantation

Krishnan A, Molina A, Zaia J, Smith D, Vasquez D, Kogut N, Falk PM, Rosenthal J, Alvamas J, Forman SJ (2005) Durable remissions with autologous stem cell transplantation for high-risk HIV-associated lymphomas. Blood 105 874-878... 

BCV (high-dose with autologous stem cell transplant)3 Carmustine 400 mg/m2 IV x 1 day Etoposide 800 mg/m2 IV daily x 3 days Cyclophosphamide 1800 mg/m2 IV daily x 4 days... 

BEAM (high-dose with autologous stem cell transplant)3... 

The primary goal in the treatment of multiple myeloma is to decrease tumor burden and minimize complications associated with the disease. A watch and wait approach is an option for asymptomatic patients who have no lytic lesions in the bone. Once symptoms occur, treatment is required. Chemotherapy can be used to reduce tumor burden in patients with symptomatic disease, but increasingly, immunomodula-tors such as thalidomide and dexamethasone are initial therapy. Almost all patients will become refractory to initial treatment and will require the use of salvage therapies such as bortezomib. Autologous stem cell transplantation prolongs overall survival in patients who can tolerate high-dose chemotherapy and may be the treatment of choice for many patients. 

Discuss whether this patient is a candidate for autologous stem cell transplantation. 

Jayne D, Passweg J, Marmont A, et al Autologous stem cell transplantation for systemic lupus erythematosus. Lupus 2004 13 168-176. 

Brinkman D, de Kleer I, ten Cate R, et al Autologous stem cell transplantation in children with severe progressive systemic or polyarticular juvenile idiopathic arthritis. Arthritis Rheum 2007 56 2410-2421. 

Shimoni A, Zwas ST, Oksman Y, Hardan I, et al. 2007. Yttrium-90-ibritumomab tiuxetan (Zevalin) combined with high-dose BEAM chemotherapy and autologous stem cell transplantation for chemo-refractory aggressive non-Hodgkin s lymphoma. Exp Hematol. 35 534-540. 

Passweg, J. and Tyndall A. (2007). Autologous stem cell transplantation in autoimmune diseases. Semin. Ilemalol. 44 278-285. 

A. Boudreau, N. Pennell, D. Combs, and N.L. Berinstein. 2003. Pharmacokinetic study of patients with follicular or mantle cell lymphoma treated with rituximab as in vivo purge and consolidative immunotherapy following autologous stem cell transplantation. Aran. Oncol. 14 758—765. 

Abbreviations ASTAMI, autologous stem cell transplantation in acute myocardial infarction BOOST, bone marrow transfer to enhance ST-elevation infarct regeneration Ctrl, control EF, ejection fraction IC, intracoronary N, number Tx, treated REPAIR-AMI, reinfusion of enriched progenitor cells and infarct remodeling in acute myocardial infarction TOPCARE-AMI, transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction. 

Press, O. W., Eary, J. F., Appelbaum, F. R., Martin, P. J., Nelp, W. B., Glenn, S., Fisher, D. R., Porter, B., Matthews, D. C., Gooley, T. et al. (1995). Phase II trial of 131I-B1 (anti-CD20) antibody therapy with autologous stem cell transplantation for relapsed B cell lymphomas. Lancet 346, 336-340. 

Kozak T, Havrdova E, Pitha I, Gregor a E, Oitlik R, Maaloufova I, Kobylka P, Vodrarkora S (2001) Immunoblative therapy with autologous stem cell transplantation in die treatment of poor risk multiple sclerosis. Transplant Proceed 33 2179—2181. 

A 50-year-old man with history of chronic hepatitis B had transient rises in serum transaminases after two successive episodes of autologous stem cell transplantation, with spontaneous resolution at that time PCR for hepatitis B virus was negative (76). Later he was given thalidomide and after 5 months suddenly experienced dizziness and jaundice. The concentration of hepatitis B virus DNA was 1641 pg/ml and serological tests for other viruses were negative. Despite conventional supportive care, he died of septicemic shock caused by Klebsiella pneumonia. Other hepatotoxic agents were excluded. 

Houck W, Einhorn LH. Secondary leukemias in germ cell tumor patients undergoing autologous stem cell transplantation utilizing high-dose etoposide. Proc ASCO 2003 22 A1566. 

A, Cadiot D, et al. Prognostic factors for survival and response after high-dose therapy and autologous stem cell transplantation in systemic AL amyloidosis a report on 21 patients. Br J Hematol 1998 101 ... 

Kroger N. Frick M. Glisz O. et al. Randomized trial of single compared with tandem high-dose chemotherapy followed by autologous stem-cell transplantation in patients with chemotherapy-sensitive metastatic breast cancer. J Clin Oncol 1WS6.24, 3919-3926. 

Kewalramani T, Zelenetz AD, Nimer SD, et al. Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma. Blood 2004 103 3684-3688. 

Linker CA. Autologous stem cell transplantation for acute myeloid leukemia. Bone Marrow Transplant 2003 31 731-738. 

Meisenberg BR, Ferran K, Hollenbach K, et al. Reduced charges and costs associated with outpatient autologous stem cell transplantation. Bone Marrow Transplant 1999 21 927-932. 

Stein AS, O Donnell MR, Slovak ML, et al. Interleukin-2 after autologous stem cell transplantation for adult patients with acute myeloid leukemia in first complete remission. J Clin Oncol 2003 21 615-623. 

Fung HC, Cohen S, Rodriguez R, et al. Reduced-intensity allogeneic stem cell transplantation for patients whose prior autologous stem cell transplantation for hematologic malignancy failed. Biol Blood Marrow Transplant 2003 9 649-656. 

Demirer T, Ayli M, Dagli M et al. (2002). Influence of post-transplant recombinant human granulocyte colony stimulating factor administration on per-transplant morbidity in patients undergoing autologous stem cell transplantation. Br J Haematol, 118, 1104-1111. 

Phase 11 trial of l-Bl (anti-CD20) antibody therapy with autologous stem cell transplantation for relapsed B cell lymphomas. Lancet 1995 346 336-340. 

Press OW, Eary JE, Gooley TA, Gopal AK, Liu S, Rajendran JG, et al. A phase 1/11 trial of io-dine-131-tositumomab (anti-CD20), etoposide, cyclophosphamide, and autologous stem cell transplantation for relapsed B-cell lymphomas. Blood 2000 96 2934-2942. 

Twenty months after finishing her chemotherapy, the woman had a relapse of breast cancer. The cancer was now unresponsive to standard doses of chemotherapy. The decision was made to treat the patient with high-dose chemotherapy followed by autologous stem cell transplantation. Which of the following drugs is most likely to be used to mobilize the peripheral blood stem cells needed for the patient s autologous stem cell transplantation ... 

Nademanee A et al. A phase 1/2 trial of high-dose yttrium-90-ibritumomab tiuxetan in combination with high-dose etoposide and cyclophosphamide followed by autologous stem cell transplantation in patients with poor-risk or relapsed non-Hodgkin lymphoma. Blood 2005 106 2896-2902. 

In a study intravenous zoledronic acid 4 mg every 4 weeks with alternate day prednisolone was given with or without thalidomide 200 mg daily for up to 1 year. The zoledronic acid pharmacokinetics were not affected by thalidomide and based on renal function no clinically adverse interaction occurred during concurrent use. The subjects in this study were patients with multiple myeloma with no disease progression 6 weeks after autologous stem-cell transplantation and conditioning with melphalan. ... 

Stem Cell Transplant. Stem cells can be found in either the bone marrow or the peripheral circulating blood. They also can be found in umbilical cord blood and fetal marrow and liver. Before stem cells can be harvested from a donor, mobilization of stem cells into the peripheral blood is stimulated by the use of cytokines. A process called apheresis is used to collect the stem cells from the donor s blood. These harvested stem cells are then injected into the patient. As with a bone marrow transplant, it is also possible to perform an autologous stem cell transplant. The transplanted patient will usually begin to produce new blood cells ten to twenty-one days after receiving the harvested stem cells. 

Fig. 27.8. Neutropenic febrile patient who underwent autologous stem-cell transplantation due to non-Hodgkin lymphoma. At day 2 after transplantation, neutropenia and fever occurred. Therefore, antifungal treatment (Amphotericin B) was started. Ill-defined pulmonary nodules were diagnosed at day 7. Haematological reconstitution took place at day 13, si-...

In 15 patients who underwent autologous stem-cell transplantation and who received sickle cell disease, oral and intestinal mucositis were significantly less severe [16 ]. Adverse reactions that were attributable to the drug included erythema, mild rashes, pruritus, nasal congestion, and low-grade fever. All the compfications were easily manageable and resolved after completion of treatment. 

Skinner M, Sanchorawala V, Seldin DC, et al. High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis an 8-year study. Ann Intern Med 2004 140(2) 85-93. 

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