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HIGH-DOSE TREATMENT + AUTOLOGOUS PERIPHERAL BLOOD PROGENITOR CELLS ALLOGRAFTING

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HIGH-DOSE TREATMENT + AUTOLOGOUS PERIPHERAL BLOOD PROGENITOR CELLS ALLOGRAFTING. HIGH DOSE TREATMENT AND ALLOGRAFTING. TERMINOLOGY CONFUSING (USED IMPRECISELY ). HIGH DOSE TREATMENT ‘BEAM’ SUPPORTED BY: AUTOLOGOUS

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Presentation Transcript
slide1
HIGH-DOSE TREATMENT

+

AUTOLOGOUS PERIPHERAL

BLOOD PROGENITOR CELLS

ALLOGRAFTING

INCTR

2004

high dose treatment and allografting
HIGH DOSE TREATMENT AND ALLOGRAFTING

TERMINOLOGY CONFUSING (USED IMPRECISELY)

HIGH DOSE TREATMENT

‘BEAM’ SUPPORTED BY: AUTOLOGOUS

PERIPHERAL BLOOD PROGENITOR CELLS (PBPC)

INCTR

2004

high dose treatment and allografting3
HIGH DOSE TREATMENT AND ALLOGRAFTING

ALLOGRAFTS

- SIBLING OR MATCHED UNRELATED DONOR (MUD)

(NOW VOLUNTEER UNRELATED DONOR, VUD)

-MYELOABLATIVEe.g.CYCLOPHOSPHAMIDE + TBI

NONMYELOABLATIVE/REDUCED INTENSITY

e.g.FLUDARABINE + MELPHALAN +/- CAMPATH

INCTR

2004

slide4
HIGH DOSE TREATMENT AND ALLOGRAFTING

PERSPECTIVES and QUESTIONS

INDICATIONS in ADULTS

INDICATIONS in CHILDREN

SITUATION in INDIA

SITUATION in PAKISTAN

ALLOGRAFTING IN RIYADH

INCTR

2004

slide5
HIGH DOSE TREATMENT AND ALLOGRAFTING

DISCUSSION

HIGH-DOSE TREATMENT + AUT. PBPC

- adults

- children

ALLOGRAFTING

- adults

- children

INCTR

2004

slide6
HIGH DOSE TREATMENT AND ALLOGRAFTING

QUESTIONS - IN DEVELOPING COUNTRY SETTING

1) WHAT IS THE MORTALITY?

INCTR

2004

slide7
HIGH DOSE TREATMENT AND ALLOGRAFTING

QUESTIONS ctd.

2)WHAT DO YOU NEED TO DO IT?

INCTR

2004

slide8
HIGH DOSE TREATMENT AND ALLOGRAFTING

QUESTIONS ctd.

3) WHAT ARE THE INDICATIONS?(IF ANY?)

- in adults?

- in children?

INCTR

2004

slide9
HIGH DOSE TREATMENT AND ALLOGRAFTING

QUESTIONS:

4) IS IT A JUSTIFIABLE COST?

- IN ECONOMIC and ‘HUMAN’ TERMS?

INCTR

2004

slide10
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

INCTR

2004

allografting
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

INCTR

2004

slide12
HIGH DOSE TREATMENT AND ALLOGRAFTING

COST - ST. BARTHOLOMEW’S HOSPITAL:

HIGH-DOSE TREATMENT: 27,000$

ALLOGRAFT (EITHER KIND): 45,000$

INCTR

2004

slide13
HIGH DOSE TREATMENT

INDICATIONS IN ADULTS:

DIFFUSE LARGE B-CELL LYMPHOMA:2nd CR/PR

CURE:40% - 55%

HODGKIN’S LYMPHOMA:2nd/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%

INCTR

2004

slide15
INCTR

2004

slide16
OVERALL SURVIVAL : SBH

DIFFUSE LARGE B CELL LYMPHOMA

100

80

60

CUMULATIVE % SURVIVING

40

n= 701

20

5

10

15

20

25

30

TIME (YEARS)

INCTR

2004

slide17
DIFFUSE LARGE B-CELL LYMPHOMA: REMISSION DURATION

100

80

60

N= 387

CUMULATIVE % IN REMISSION

40

20

5

10

15

20

25

30

INCTR

2004

TIME (YEARS)

slide18
HIGH-DOSE TREATMENT FOR DLBC LYMPHOMA:SBH

1.00

0.75

REMISSION N=77

0.50

SURVIVAL N=77

0.25

0.00

0

0

2

2

4

4

6

6

8

8

10

10

12

12

14

14

16

16

years

WITH THANKS TO ANDY DAVIS and ANDY WILSON

INCTR

2004

slide19
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

INCTR

2004

slide20
HIGH DOSE TREATMENT

INDICATIONS IN ADULTS:

DIFFUSE LARGE B-CELL LYMPHOMA:2nd CR/PR

CURE:30 - 40%

HODGKIN’S LYMPHOMA:2nd/subsequent CR/PR

CURE 30 - 40%

MYELOMA: younger pts. 1st.remission

CURE probably none

ALL: 2nd. CR

CURE 25 - 30%

INCTR

2004

ifm90 overall survival 200 patients intention to treat analysis
IFM90 - OVERALL SURVIVAL200 patients, ‘Intention to treat’ analysis

VMCP/VBAP 4-6 courses,Mel140 +TBI,IFN

INCTR

2004

Attal et al, NEJM 1996

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