Very High Dose Therapy in Lymphomas and Solid Tumors

  • T. Philip
  • R. Pinkerton
Part of the UICC International Union Against Cancer book series (UICCI)

Abstract

Allogenic bone marrow transplantation is now a major treatment in hematology both for severe aplastic anemia and following intensive chemoradiotherapy regimens for chronic myeloid leukemia, high-risk acute lymphoblastic leukemia, and acute myeloid leukemia. It is also the sole therapy available in some severe combined immunodeficiencies and genetic defects. In the leukemias—with the exception of the graft-versus-leukemia effect, and unlike the other conditions mentioned—the use of marrow transplantation is not therapeutic per se, but simply a method by which high-dose, often curative therapy can be given without regard to marrow toxicity. Applying the same principle to lymphoma and solid tumors has allowed the selection of the most active agents for use in combinations, at doses limited only by extramedullary toxicity. However, the availability of HLA- and DR-matched allograft is limited by the lack of a matched sibling marrow for three-quarters of all patients, and there is a high incidence of lethal graft-versus-host disease in patients aged over 35 years. Other options are to use either autologous grafts or mismatched allografts. At present, autologous bone marrow transplantation (ABMT) is clearly the alternative of choice. ABMT is currently used either to shorten the period of aplasia after nonablative high-dose chemotherapy or as a rescue after massive, presumptively lethal myeloablative chemotherapy, often with total body irradiation (TBI). The successful use of ABMT in adults was first described by McFarland [1] in 1959, and in children by Clifford in 1961 [2].

Keywords

Leukemia Oncol Sarcoma Doxorubicin Methotrexate 

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© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • T. Philip
  • R. Pinkerton

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