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Long-Term Survival and Late-Onset Complications of Cancer Patients Treated With High-Dose Chemotherapy Followed by Autologous Peripheral Blood Stem Cell Transplantation

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Abstract

The antitumor effect of high-dose chemotherapy (HDC) followed by autologous peripheral blood stem cell transplantation (auto-PBSCT) is considered superior to that of conventional chemotherapy. However, the long-term benefits of this strategy in Japan remain unclear.Therefore, in this study, 109 cancer patients enrolled between 1989 and 1999 were treated with HDC and auto-PBSCT. Patients were evaluated for long-term survival and late-onset complications, including secondary malignancy. The mean number of CD34+ cells harvested per apheresis was larger in the group receiving high-dose cytosine arabinoside or high-dose etoposide plus granulocyte colony-stimulating factor (G-CSF) than in the group receiving conventional chemotherapy plus G-CSF. The 5-year overall survival rates for non-Hodgkin’s lymphoma patients in first complete remission (CR) (83.2%), second or subsequent CR (74.1%), or first partial remission (PR) (66.7%) at the time of transplantation were significantly higher than those with no remission (35.7%) at the time of transplantation (first CR,P < .05; second or subsequent CR,P < .05; first PR,P < .05). The 5-year overall survival (OS) rates for breast cancer was 40.8%, and the disease-free survival rate was extremely low (8.8%). The 5-year OS rates for chemotherapy-sensitive and chemotherapy-resistant diseases at the time of transplantation were 32.7% and 35.7%, respectively, a difference that was not considered significant. The 5-year OS for germ cell tumor was 80.0%, and the disease-free survival rate was 77.9%. The rate of therapy-related death was 8.2%. The occurrence rate of secondary malignancy was 0.9%. Late-onset complications were observed in 4 cases (glomerulonephritis, interstitial pneumonitis, ulcerative colitis, and acute myelogenous leukemia). At 3.7%, the occurrence rate was not very high, but most complications of auto-PBSCT were life threatening and interfered with patients’ quality of life. A careful follow-up is required for at least 2 years after transplantation, because the mean occurrence time of late-onset complications is 16.7 months posttransplantation.

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Author information

Correspondence to Kyuhei Kohda or Sumio Sakamaki or Takuya Matsunaga or Takashi Kuga or Akihito Fujimi or Yuichi Konuma or Toshiro Kusakabe or Katsuhisa Kogawa or Takehide Akiyama or Kazuhiko Koike or Yasuo Hirayama or Yutaka Sasagawa or Syuichi Nojiri or Yasuji Hirata or Takuji Nishisato or Yoshiro Niitsu.

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Kohda, K., Sakamaki, S., Matsunaga, T. et al. Long-Term Survival and Late-Onset Complications of Cancer Patients Treated With High-Dose Chemotherapy Followed by Autologous Peripheral Blood Stem Cell Transplantation. Int J Hematol 73, 251–257 (2001). https://doi.org/10.1007/BF02981946

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Key words

  • High-dose chemotherapy
  • auto-PBSCT
  • Secondary malignancy
  • Solid tumor
  • G-CSF