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HIGH-DOSE TREATMENT + AUTOLOGOUS PERIPHERAL BLOOD PROGENITOR CELLS ALLOGRAFTING

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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HIGH-DOSE TREATMENT + AUTOLOGOUS PERIPHERAL BLOOD PROGENITOR CELLS ALLOGRAFTING

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  1. HIGH-DOSE TREATMENT + AUTOLOGOUS PERIPHERAL BLOOD PROGENITOR CELLS ALLOGRAFTING INCTR 2004

  2. HIGH DOSE TREATMENT AND ALLOGRAFTING TERMINOLOGY CONFUSING (USED IMPRECISELY) HIGH DOSE TREATMENT ‘BEAM’ SUPPORTED BY: AUTOLOGOUS PERIPHERAL BLOOD PROGENITOR CELLS (PBPC) INCTR 2004

  3. 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

  4. 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

  5. HIGH DOSE TREATMENT AND ALLOGRAFTING DISCUSSION HIGH-DOSE TREATMENT + AUT. PBPC - adults - children ALLOGRAFTING - adults - children INCTR 2004

  6. HIGH DOSE TREATMENT AND ALLOGRAFTING QUESTIONS - IN DEVELOPING COUNTRY SETTING 1) WHAT IS THE MORTALITY? INCTR 2004

  7. HIGH DOSE TREATMENT AND ALLOGRAFTING QUESTIONS ctd. 2)WHAT DO YOU NEED TO DO IT? INCTR 2004

  8. HIGH DOSE TREATMENT AND ALLOGRAFTING QUESTIONS ctd. 3) WHAT ARE THE INDICATIONS?(IF ANY?) - in adults? - in children? INCTR 2004

  9. HIGH DOSE TREATMENT AND ALLOGRAFTING QUESTIONS: 4) IS IT A JUSTIFIABLE COST? - IN ECONOMIC and ‘HUMAN’ TERMS? INCTR 2004

  10. 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

  11. 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

  12. HIGH DOSE TREATMENT AND ALLOGRAFTING COST - ST. BARTHOLOMEW’S HOSPITAL: HIGH-DOSE TREATMENT: 27,000$ ALLOGRAFT (EITHER KIND): 45,000$ INCTR 2004

  13. 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

  14. DIFFUSE LARGE B CELL LYMPHOMA CD20+ INCTR 2004

  15. INCTR 2004

  16. 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

  17. 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)

  18. 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

  19. 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

  20. 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

  21. 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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