Bone Marrow Transplantation

Bone marrow transplantation is an offshoot of whole organ transplantation.2 Allogeneic BMT involves infusing marrow cells from an immunologically compatible donor to the patient being treated. It had been applied therapeutically mainly to hematologic disorders and was described as curative for severe immunodeficiency, aplastic anemia, thalassemia, and leukemia and lymphoma (Hansen et al. 1989). Autologous BMT involves extracting a patient's marrow, preserving it through a freezing process,...

High Dose Chemotherapy

The appropriate dosage for cancer chemotherapy has long been debated within oncology. In 1980, Frei and Canellos argued that the importance of the dose of chemotherapy drugs was insufficiently appreciated. Chemotherapy drugs were so toxic that any suggestion that the dose-response curve was not steep or that lower doses were as effective as higher ones led oncologists to administer lower doses. They argued that the toxicity of antitumor agents was strongly dose related for both tumor and normal...

Oncology Legitimates an Experimental Procedure

The limited commitment to randomized trials was reflected in several statements that emanated from the AMA. Its Diagnostic and Therapeutic Technology Assessment (DATTA) program solicited the opinions of clinicians rather than systematically reviewing the literature. In an early 1990 poll of 45 oncologists on ABMT, an overwhelming majority rated the safety and effectiveness of ABMT as established or promising (AMA DATTA 1990). Although the report limited itself to acute lymphocytic leukemia,...

Research Methodologies

We used a number of different methodologies in the preparation of this book. We made extensive use of semistructured interviews with key actors for every stage of the research and analysis. Some individuals were interviewed more than once, and we often established a continuing conversation with some individuals. Although some interviews were conducted over the telephone, most were face-to-face, and some involved full-day site visits. Most interviews identify the interviewee and the date of the...

Adjuvant Chemotherapy

Historically, primary treatment of breast cancer by surgery, or surgery with radiation, assumed that the cancer was physically confined to the breast. But, high recurrence after treatment led clinicians to believe that submicroscopic or occult cancers typically spread from the primary tumor to other areas of the body before diagnosis and primary treatment with surgery and radiotherapy (I. C. Henderson 1985, p. 140). Adjuvant therapy the use of cytotoxic drugs after primary therapy developed as...

Whats in a Name

When first developed, HDC ABMT was often described as BMT or ABMT (or sometimes AuBMT). In time, the procedure came to be referred to as HDC ABMT. This acknowledges that treatment is HDC made possible by transplantation, a rescue procedure from an otherwise lethal dose of chemotherapy. Autologous refers to bone marrow from the patient herself allogeneic bone marrow is donated by another individual. As the procedure developed, treatment was also described as HDC with peripheral blood (or...

Breast Cancer and Its Treatment

It is the second leading cause of cancer death among women (representing 15 of all cancer deaths), compared to 25 of cancer deaths from lung cancer (American Cancer Society ACS 2004). Estimated deaths from breast cancer in 2003 were 39,800 for women and 400 for men. Mortality rates for breast cancer declined significantly in recent years, mostly among young women, both white and black, falling 1.4 annually in 1989-1995 and then at a rate of 3.2 annually....

Stamp I Stamp Ii Stamp Iii Stamp Iv Stamp V

Cyclophosphamide, cisplatin, carmustine (BCNU) Ifosfamide, carboplatin, etoposide Cyclophosphamide, thiotepa (antibiotic protocol) Cyclophosphamide, thiotepa, carboplatin a The letter sequence in a combination regimen corresponds to the sequence in which the individual chemotherapy drugs are administered. disease, suggesting that the dose-response curve would be steeper in the adjuvant (or early-stage) setting than in the metastatic setting. This appeared to be true for the CMF regimen in...

Combination Chemotherapy

A basic limitation of cancer therapy is the resistance of tumors to cytotoxic drugs (I. C. Henderson et al. 1988). Combination chemotherapy developed as a way to overcome resistance. By the 1970s, it had been shown that metastatic breast cancer was moderately sensitive to single-agent chemotherapy (DeVita and Schein 1973). Several groups of cytotoxic agents were identified as active against metastatic breast cancer, including the alkylating agents (cyclophosphamide, thiotepa, L-phenylalanine...

The Story in Brief A Fateful Branching

What do these cases illustrate They indicate the intense hope and fear that drove women with a diagnosis of breast cancer to seek an experimental treatment presumed to offer better prospects than conventional therapy. They suggest the dependence of women on the advice they receive from their physicians, especially when a treatment is characterized as the only chance for a cure. The cases show how the demands of these women were expressed forcefully to and through families, physicians, clergy,...