INCTR

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HIGH-DOSE TREATMENT
AUTOLOGOUS PERIPHERAL BLOOD PROGENITOR
CELLS ALLOGRAFTING
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HIGH DOSE TREATMENT AND ALLOGRAFTING

• TERMINOLOGY CONFUSING (USED IMPRECISELY)

HIGH DOSE TREATMENT BEAM SUPPORTED
BY AUTOLOGOUS PERIPHERAL BLOOD PROGENITOR
CELLS (PBPC)
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HIGH DOSE TREATMENT AND ALLOGRAFTING

• ALLOGRAFTS

- SIBLING OR MATCHED UNRELATED DONOR (MUD)

(NOW VOLUNTEER UNRELATED DONOR, VUD)
- MYELOABLATIVE e.g.CYCLOPHOSPHAMIDE TBI
NONMYELOABLATIVE/REDUCED INTENSITY
e.g.FLUDARABINE MELPHALAN /- CAMPATH
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HIGH DOSE TREATMENT AND ALLOGRAFTING
PERSPECTIVES and QUESTIONS INDICATIONS
in ADULTS INDICATIONS in
CHILDREN SITUATION in INDIA
SITUATION in PAKISTAN
ALLOGRAFTING IN RIYADH

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HIGH DOSE TREATMENT AND ALLOGRAFTING
DISCUSSION HIGH-DOSE TREATMENT AUT. PBPC -
adults - children ALLOGRAFTING - adults -
children

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HIGH DOSE TREATMENT AND ALLOGRAFTING
QUESTIONS - IN DEVELOPING COUNTRY SETTING 1)
WHAT IS THE MORTALITY?

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HIGH DOSE TREATMENT AND ALLOGRAFTING
QUESTIONS ctd. 2)WHAT DO YOU NEED TO DO IT?

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HIGH DOSE TREATMENT AND ALLOGRAFTING
QUESTIONS ctd. 3) WHAT ARE THE INDICATIONS?(IF
ANY?) - in adults? - in children?

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HIGH DOSE TREATMENT AND ALLOGRAFTING
QUESTIONS 4) IS IT A JUSTIFIABLE COST? - IN
ECONOMIC and HUMAN TERMS?

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HIGH-DOSE TREATMENT
AUTOLOGOUS PBPC

• EUROPE NORTH AMERICA MANY HOSPITALS

MORTALITY 1 2
NEEDS EXPERIENCED MEDICAL NURSING STAFF
SINGLE ROOMS BATHROOM and TOILET
INFRASTRUCTURE FOR COLLECTING CELLS
LAB FOR FREEZING CELLS
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ALLOGRAFTING

• AFFLUENT COUNTRIES FAR FEWER CENTRES
• MORTALITY CORRELATES WITH AGE
• FULL ALLOGRAFT 20 - 25
• NON-MYELOABLATIVE 10 - 15

NEEDS EXPERIENCED MEDICAL NURSING STAFF
SINGLE ROOMS etc. PROBLEMS LACK OF HLA
IDENTICAL SIBLING DONORS ACUTE AND CHRONIC GRAFT
vs HOST DISEASE
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HIGH DOSE TREATMENT AND ALLOGRAFTING
COST - ST. BARTHOLOMEWS HOSPITAL HIGH-DOSE
TREATMENT 27,000 ALLOGRAFT (EITHER
KIND) 45,000

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HIGH DOSE TREATMENT
INDICATIONS IN ADULTS DIFFUSE LARGE B-CELL
LYMPHOMA2nd CR/PR CURE40 - 55 HODGKINS
LYMPHOMA2nd/subsequent CR/PR CURE 30 -
40 MYELOMA younger pts. 1st.remission CURE
probably none, but prolongation of survival and
better Quality of Life ALL 2nd. CR CURE 25 -
30

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DIFFUSE LARGE B CELL LYMPHOMA
CD20
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(No Transcript)
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(No Transcript)
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DIFFUSE LARGE B-CELL LYMPHOMA REMISSION DURATION
100
80
60
N 387
CUMULATIVE IN REMISSION
40
20
5
10
15
20
25
30
TIME (YEARS)
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HIGH-DOSE TREATMENT FOR DLBC LYMPHOMASBH
1.00
0.75
REMISSION N77
0.50


SURVIVAL N77
0.25
0.00
0
2
4
6
8
10
12
14
16
0
2
4
6
8
10
12
14
16
years
WITH THANKS TO ANDY DAVIS and ANDY WILSON
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HIGH-DOSE TREATMENT
AUTOLOGOUS PBPC

• DIFFUSE LARGE B-CELL LYMPHOMA
• MOST IMPORTANT PROGNOSTIC FACTOR
• IS REMISSION STATUS AT TIME OF HDT
• PERSON MUST BE IN REMISSION!
• OTHERWISE NOT WORTH DOING

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HIGH DOSE TREATMENT
INDICATIONS IN ADULTS DIFFUSE LARGE B-CELL
LYMPHOMA2nd CR/PR CURE30 - 40 HODGKINS
LYMPHOMA2nd/subsequent CR/PR CURE 30 -
40 MYELOMA younger pts. 1st.remission CURE
probably none ALL 2nd. CR CURE 25 - 30

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IFM90 - OVERALL SURVIVAL200 patients, Intention
to treat analysis
VMCP/VBAP 4-6 courses,Mel140 TBI,IFN

Attal et al, NEJM 1996