Stem Cells and Cancer Stem Cells, Volume 10 by M.A. Hayat

Author:M.A. Hayat
Language: eng
Format: epub
Publisher: Springer Netherlands, Dordrecht

High-Dose Therapy

The term “conditioning regimen” is used for the high dose treatment before re-infusion of stem cells, originating from its use in the allogeneic stem cell transplantation setting, where it reduces the host immune function so that the re-infused allogeneic bone marrow cells are not rejected by the patient. In HDT the purpose of the conditioning regimen is complete eradication of the malignant cells. In animal models, there is a linear-logarithmic relationship between drug dose and the killing of tumour cells. The drugs used show a steep dose-response relationship between chemotherapy-dose and the killing of tumour cells, have short half-life and myelotoxicity as the major (only) dose-limiting side effect.

The most widely used regimens for lymphoid malignancies are either a combination of fractionated total body radiation (TBI), 10–14 Gy followed by cyclophosphamide (1.2 g/m2 2 days in a row) or carmustine (BCNU), etoposide, cytarabin, melphalan (BEAM). Melphalan may be substituted with cyclophosphamide in the BEAC regimen. The procedure related mortality rate has dropped substantially from the mid 1980s (10–15%) till today (approximately 1%). This drop is most probably due to shorter cytopenia duration after stem cell harvest from peripheral blood, to better patient selection and to improved supportive care during aplasia. In an unpublished series of all 711 Norwegian lymphoma patients undergoing HDT since 1987 until 2008, 10 year overall survival is 55%, ranging from 45 to 75% for the various entities. For many of the entities, there are few deaths beyond 5 years after HDT, indicating that a high percentage of these patients are cured from their disease.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.