Role for high-dose therapy with autologous hematopoietic stem cell support in XXXX .

@entity1 @entity137 @entity10043 @entity3601 @entity1582 @entity3118 @entity348 @entity8057
Despite effectiveness of standard chemotherapy regimens, complete responses are infrequent in @entity8057 ( @entity8057 ) and there are no cures. Since @entity8057 shares certain biological and clinical features with @entity1582 , including responsiveness to alkylating agents, evaluation of high-dose therapy (HDT) with transplant, which is effective in @entity1582 , is an obvious next step in an effort to achieve high response rates and improve survival. Due to the indolent nature of the disease and older @entity1 with comorbidities, such evaluations have been infrequent in the past. We have evaluated the safety and efficacy of high-dose melphalan with peripheral blood stem cell (PBSC) support in eight @entity1 between the ages of 45 and 69 years with @entity8057 . Adequate numbers of stem cells were collected in six @entity1 ; however, two @entity1 with more extensive prior @entity3118 therapy failed to collect adequate cells and required a second attempt at stem cell collection. Seven @entity1 were treated with @entity3601 200 mg/m(2), including two @entity1 who received tandem transplants; one @entity1 received melphalan 140 mg/m(2) with @entity348 ( @entity348 ). There was no treatment-related mortality and @entity137 were manageable. Recovery of bone marrow after transplant was prompt except in one @entity1 with extensive prior use of @entity3118 . All the eight @entity1 achieved at least partial response (PR), including one complete response (CR). Five @entity1 are alive and with out relapse (77+ to 6+ months post-transplant). Other investigators have reported similar experience suggesting safety and efficacy of HDT in @entity8057 . However, therapy with @entity10043 analogues leads to stem cell damage with decreased ability to collect adequate numbers of stem cells. This suggests that the PBSCs should preferably be procured prior to extensive use of @entity10043 analogues. Future strategies in @entity8057 will include a plan to evaluate the role of HDT along with biological agents, role of purging using rituximab, post-HDT maintenance strategies (including immunotherapy), and evaluation of nonmyeloablative regimens containing @entity3118 to achieve higher response rates and improve survival.
