High-dose chemotherapy with peripheral blood progenitor autografting

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Abstract
There is increasing evidence that dose-intensification of cytotoxic agents can partially overcome the drug resistance of the cancer cell [1]. In the clinic, this strategy also results in increased toxicity to normal tissues. For those cytotoxics that are primarily dose-limited by myelosuppression (e.g., alkylating agents, carboplain, and etoposide), the use of autologous bone marrow transplantation (ABMT) has facilitated substantial dose escalation. This procedure involves the ‘harvesting’ of bone marrow from the iliac bone under general anesthesia. The marrow is then cryopreserved and can be used as a form of hematopoietic rescue following subsequent myelosuppressive chemotherapy. Very-high-dose chemotherapy supported in this way produces high rates of complete response in patients with lymphoma [2], germ cell tumors [3], and breast cancer [4] who have failed to respond to, or had relapsed following treatment with, more conventional doses of the same agents. Some patients achieve prolonged disease-free survival and are possibly cured. This modality has been associated with substantial morbidity and morality, however, principally due to the relatively prolonged period of pancytopenia prior to hematopoietic recovery.

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