Assuntos
Azacitidina/administração & dosagem , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/mortalidade , Quimioterapia de Manutenção , Talidomida/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Lenalidomida , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Talidomida/administração & dosagemRESUMO
INTRODUCTION: Limited data is available on the feasibility of high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (AHSCT) in elderly patients over 70 years of age with non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: In the setting of the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC) group, we retrospectively analyzed 81 consecutive patients with NHL over 70 years of age who received AHSCT. RESULTS: The median age at AHSCT was 72.3 years [70-80]. Patients' were diagnosed with diffuse large B-cell lymphoma (n=40), follicular lymphoma (n=16), mantle cell lymphoma (n=15), T-cell lymphoma (n=5), and other (n=5). Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) was 0 in 73% of patients. Main conditionings were BEAM (Carmustine-Etoposide-Cytarabine-Melphalan, n=61) and melphalan alone (n=14). Median delays to reach 0.5×109/L neutrophils and 20 × 10(9)/L platelets were of 12 [9-76] days and 12 [0-143] days, respectively. One hundred day and one year cumulative incidence of NRM was 5.4% and 8.5%, respectively. The main cause of death remains relapse. CONCLUSION: In conclusion, this study revealed that AHSCT seemed to be acceptable in patients over 70 years of age with NHL. Patient age is not a limiting factor if clinical condition is adequate.
Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , Linfoma não Hodgkin/terapia , Sociedades Médicas , Idoso , Idoso de 80 Anos ou mais , Transplante de Medula Óssea , Terapia Baseada em Transplante de Células e Tecidos , Intervalo Livre de Doença , Feminino , Seguimentos , França/epidemiologia , Humanos , Incidência , Linfoma não Hodgkin/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Taxa de Sobrevida/tendênciasRESUMO
In a previous prospective study on 62 patients who underwent an HLA-matched allogeneic stem cell transplantation, we have observed that proportion of donor-derived CCR7(+)/CD4(+) T cells in the graft provided a predictive indicator of acute GVHD without interfering on chronic GVHD and relapse rate. Here we present our results on a confirmatory cohort of 137 consecutive patients. Indeed patients who received more than 76% of CCR7(+)/CD4(+) T cells in the graft developed more often acute GVHD be it of low or high grade than those who did not. Determination of the CCR7(+)/CCR7(neg) ratio of CD4(+) T cells in the graft provides a predictive indicator of acute GVHD and could help to define strategies of partial selective T cell depleted transplantation.
Assuntos
Transplante de Medula Óssea , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/transplante , Doença Enxerto-Hospedeiro/imunologia , Memória Imunológica , Transplante de Células-Tronco de Sangue Periférico , Subpopulações de Linfócitos T/transplante , Doença Aguda , Adolescente , Adulto , Idoso , Aloenxertos/imunologia , Linfócitos T CD4-Positivos/imunologia , Criança , Feminino , Sobrevivência de Enxerto/imunologia , Neoplasias Hematológicas/terapia , Humanos , Imunofenotipagem , Doadores Vivos , Depleção Linfocítica , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Receptores CCR7/análise , Subpopulações de Linfócitos T/imunologia , Resultado do Tratamento , Adulto JovemRESUMO
In previous studies, we observed that a high proportion of donor-derived CD4(+) T cells expressing the chemokine receptor 7 (CCR7) was a major determinant of acute GVHD, without interfering with the incidence of other post-transplant outcomes, especially relapse and nonrelapse mortality rates. Here, we investigated in vitro the impact of partially selective CD4(+)/CCR7(+) T lymphocytes on acquired anti-infective immune response in 10 donors who underwent G-CSF-primed PBSC collection. Similar quantitative and functional proliferative reactions were observed in lymphocyte cultures in the presence of adenovirus and pp65 Ags with unmanipulated and partially depleted donor samples. No responses were observed in the presence of human T-cell lymphotropic virus type 1 used as a negative control. These results complete the proof of concept needed to build a clinical trial investigating partially selective CD4(+)/CCR7(+) T cell-depleted allo-SCT.
Assuntos
Linfócitos T CD4-Positivos/transplante , Separação Celular/métodos , Doença Enxerto-Hospedeiro/prevenção & controle , Depleção Linfocítica/métodos , Transfusão de Linfócitos/métodos , Receptores CCR7/metabolismo , Doença Aguda , Adulto , Transplante de Medula Óssea/efeitos adversos , Transplante de Medula Óssea/métodos , Linfócitos T CD4-Positivos/citologia , Linfócitos T CD4-Positivos/metabolismo , Proliferação de Células , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Citometria de Fluxo/métodos , Fluoresceínas , Corantes Fluorescentes , Doença Enxerto-Hospedeiro/imunologia , Neoplasias Hematológicas/terapia , Humanos , Interferon gama/metabolismo , Transfusão de Linfócitos/efeitos adversos , Masculino , Succinimidas , Doadores de Tecidos , TrítioRESUMO
A large proportion of lower-risk myelodysplastic syndromes (MDS) respond to erythropoiesis-stimulating agents (ESA), but most responses are transient. We updated a previously reported cohort of lower-risk MDS patients treated with ESA and analyzed outcomes after ESA failure. In 120 patients with primary resistance and 66 patients with relapse after an initial response to ESA, the 5-year cumulative incidence of acute myeloid leukemia (AML) after failure was 18.9% and 11.6%, respectively (P=0.20). Median overall survival (OS) after failure was 40.1 and 44.9 months (P=0.35), respectively. We further categorized patients as 'early failures' (including resistance and relapse after <6 months of response), or 'later failures' (that is, relapse after ≥6 months). The 5-year cumulative incidence of AML and median OS after failure in early and later failure were 21.6% and 9% (P=0.02) and 36.7 and 54.3 months (P=0.02), respectively. Early failure to ESA and a baseline diagnosis of refractory anemia with excess blasts (RAEB)-1 were independent prognostic factors for AML progression and, along with trisomy 8, for shorter OS. Median OS from treatment onset was 40, 90.7 and 65.8 months in early failure, later failure and no relapse, respectively (P=0.001). Lower-risk MDS with early failure to ESA have a relatively unfavorable outcome, and should be offered alternative treatments.
Assuntos
Anemia/complicações , Cromossomos Humanos Par 5 , Hematínicos/uso terapêutico , Síndromes Mielodisplásicas/tratamento farmacológico , Feminino , Humanos , Masculino , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/genética , Recidiva , Resultado do TratamentoRESUMO
Darbepoetin (DAR), with or without granulocyte colony-stimulating factor (G-CSF), has proved effective in treating anemia in patients with lower-risk myelodysplastic syndrome (MDS), but its effects on quality of life (QoL) and exercise functioning are less well established. In this phase II study (no. NCT00443339), lower-risk MDS patients with anemia and endogenous erythropoietin (EPO) level <500 IU/L received DAR 500 µg once every 2 weeks for 12 weeks, with G-CSF added at week 12 in non-responders. Physical performance was assessed with the 6-min walking test and, for fit patients, maximal oxygen consumption (VO2max). QoL was evaluated using SF-36 and FACT-An tests. In 99 patients, erythroid response rate according to IWG 2006 criteria was 48 and 56 % at 12 and 24 weeks, respectively. Addition of G-CSF rescued 22 % of non-responders. In 48 % of the responders, interval between darbepoetin injections could be increased for maintenance treatment. Serum EPO level was the only independent predictive factor of response at 12 weeks, and its most discriminant cutoff value was 100 IU/L. QoL and VO2max showed improvement over time in responders, compared with non-responders. With a median follow-up of 52 months, median response duration was not reached, and 3-year cumulative incidence of acute myeloid leukemia and overall survival (OS) was 14.5 and 70 %, respectively. Baseline transfusion dependence, International Prognostic Score System (IPSS), and Revised IPSS accurately predicted OS from treatment onset. Tolerance of darbepoetin was good. In conclusion, this regimen of darbepoetin every 2 weeks yielded high response rates and prolonged response duration. Objective improvement in exercise testing and in patient-reported QoL confirms the clinical relevance of anemia correction with erythropoiesis-stimulating agents.
Assuntos
Eritropoetina/análogos & derivados , Tolerância ao Exercício/efeitos dos fármacos , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Síndromes Mielodisplásicas/tratamento farmacológico , Qualidade de Vida , Idoso , Anemia/complicações , Anemia/tratamento farmacológico , Anemia/mortalidade , Anemia/fisiopatologia , Darbepoetina alfa , Eritropoetina/administração & dosagem , Eritropoetina/efeitos adversos , Exercício Físico/fisiologia , Feminino , Filgrastim , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Hematínicos/administração & dosagem , Hematínicos/efeitos adversos , Humanos , Masculino , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/fisiopatologia , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Risco , Análise de Sobrevida , Resultado do TratamentoRESUMO
Leiomyoma of the uterus is a frequent benign tumor of non menopausal women. Among possible complications, polycythemia is rare and often unrecognised. We report a very demonstrative case, that of a 52-year-old woman, who presented initially an episode of metrorrhagia. The difficulty of diagnosis and the treatment are detailed. The different physiopathological hypotheses are discussed in order to ameliorate our knowledge about this association between fibromyoma and polycythemia, and to optimise therapeutic management.
Assuntos
Leiomioma/complicações , Policitemia/complicações , Neoplasias Uterinas/complicações , Feminino , Hematócrito , Hemoglobinas/análise , Humanos , Histerectomia , Leiomioma/diagnóstico , Leiomioma/terapia , Metrorragia , Pessoa de Meia-Idade , Policitemia/diagnóstico , Policitemia/terapia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapiaRESUMO
Imatinib combined with high-dose chemotherapy is now becoming the gold standard for treatment of Philadelphia chromosome-positive acute leukemias. However, in all studies imatinib dosage was tapered to 400-600 mg per day. We decided to initiate a clinical trial to evaluate an opposite strategy based on high-dose imatinib (800 mg per day) combined with a less intensive chemotherapeutic regimen (vincristine and dexamethasone), which we called the DIV induction regimen. Thirty-one patients (18 relapsing or refractory Ph+ acute lymphoblastic leukemias and 13 lymphoid blast crisis chronic myelogenous leukemias) were enrolled. Complete remission (CR) was obtained in 28 out of 30 assessable patients. The median bcr-abl/abl ratio after the induction course was 0.1%. Median time to neutrophil recovery was 21 days. Fungus infections were observed in six patients out of 31 and possibly related to dexamethasone. Neuropathy due to vincristine was noted in 14 cases. Nine out of 19 patients under 55 years received allogenic stem cell transplantation after a median time of 78 days post-CR. Patients older than 55 years experienced a 90% CR rate without additional toxicities, suggesting the DIV regimen may also be proposed as a front line therapy in older patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Crise Blástica/tratamento farmacológico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Benzamidas , Dexametasona/administração & dosagem , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Resistencia a Medicamentos Antineoplásicos , Humanos , Mesilato de Imatinib , Projetos Piloto , Piperazinas/administração & dosagem , Pirimidinas/administração & dosagem , Vincristina/administração & dosagemRESUMO
In the setting of reduced-intensity conditioning (RIC) regimens for allogeneic stem cell transplantation (allo-SCT), the epidemiology of transplant-related infections is still poorly defined. In 101 high-risk patients who received an HLA-identical sibling allo-SCT after RIC, including fludarabine, busulfan and antithymocyte globulin (ATG), we report during the first 6 months a cumulative incidence of positive CMV antigenemia of 42% (95% CI 32-52%), developing at a median of 37 (range 7-116) days without evidence of CMV disease (median follow-up, 434 days). The cumulative incidence of bacteremia was 25% (95% CI 17-33%), occurring at a median of 67 (range 7-172) days, while patients had recovered a full neutrophil count. In all, 65% of the bacteremia (95% CI 49-81%) were gram negative. The cumulative incidence of fungal infections was 8% (95% CI 3-13%), with a median onset of 89 (range 7-170) days. In multivariate analysis, stem cell source (bone marrow; P=0.0002) was significantly associated with the risk of positive CMV antigenemia, while higher doses of prednisone (>2 mg/kg) represented the major risk factor for bacteremia (P=0.0001). Infectious-related mortality was 5% (95% CI 1-9%), with aspergillosis being the principal cause. Collectively, these results suggest that prospective efforts are warranted to develop optimal antimicrobial preventive strategies after RIC allo-SCT.
Assuntos
Infecções Bacterianas/etiologia , Irmãos , Transplante de Células-Tronco/efeitos adversos , Transplante Homólogo/efeitos adversos , Viroses/etiologia , Sistema ABO de Grupos Sanguíneos , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Bacteriemia/epidemiologia , Bacteriemia/mortalidade , Infecções Bacterianas/epidemiologia , Incompatibilidade de Grupos Sanguíneos , Infecções por Citomegalovirus/prevenção & controle , Feminino , Ganciclovir/uso terapêutico , Rejeição de Enxerto/epidemiologia , Doença Enxerto-Hospedeiro/epidemiologia , Teste de Histocompatibilidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transplante de Células-Tronco/mortalidade , Análise de Sobrevida , Fatores de Tempo , Viroses/epidemiologiaRESUMO
Allogeneic hematopoietic stem cell transplantation is often used to treat hematologic malignancies. The efficacy of this procedure is due to both myeloablative conditioning and graft-versus-leukemia (GVL). However, the disadvantages of allogeneic transplantation include graft-versus-host disease (GVHD), relapse from the original tumor, and patient susceptibility to opportunistic infections. Lately, allogeneic transplantation has been developed to treat solid tumors, with the expectation that graft-versus-tumor (GVT), like GVL, will have a significant anti-tumor effect. This effect has been demonstrated in renal carcinomas, and with less evidence in breast cancers. Five patients with malignant ovarian tumors resistant to chemotherapy underwent allogeneic transplantation, four from bone marrow, and one from peripheral blood stem cells. All donors were HLA-identical siblings. One patient received a myeloablative conditioning regimen, while the other four received a non-myeloablative regimen. Two patients received donor lymphocyte infusions (DLI). Four of the patients presented with acute or chronic GVHD associated with tumor regression of at least 50%. These tumor regressions were measured by CA-125 levels and CT scans. The fifth patient died of rapid progression just after transplantation. Of the four transplantation survivors, three received a non-myeloablative regimen which did not seem to reduce treatment effectiveness. While it did reduce toxicity, one of these patients died of GVHD after 127 days. DLI was administered to two patients. These infusions seemed to promote GVHD which was able to control disease progression for one patient and had no apparent effect on the other. Allograft of hematopoietic stem cells might be of interest in ovarian cancer. The results in one patient also suggest that DLI may be an effective immunotherapy, although doses and timing need to be determined. The number of cases presented is small, however, and clinical experience on a larger scale will be required to determine the real clinical efficacy of graft versus cancerous ovarian cells.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Neoplasias Ovarianas/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/toxicidade , Feminino , Sobrevivência de Enxerto , Efeito Enxerto vs Tumor , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/mortalidade , Humanos , Transfusão de Linfócitos , Pessoa de Meia-Idade , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Projetos Piloto , Taxa de Sobrevida , Quimeras de Transplante , Transplante Homólogo/efeitos adversos , Transplante Homólogo/mortalidade , Transplante IsogênicoRESUMO
Allogeneic bone marrow transplantation is being used to treat hematologic malignancies after induction. The efficacy of this procedure is due to both myeloablative conditioning and graft versus leukemia (GvL). However, the disadvantages of allogenic transplantation include graft versus host disease (GvH), the susceptibility of patients to opportunistic infections, and relapse from the original tumor. Since 1995 is used conditioning regimen which are deeply immunosuppressive and non myeloablative. The therapeutic toxicity related to myeloablation and drug side effects should be reduced. Lately, allogeneic transplantation has been developed to treat solid tumors, with the expectation that graft versus tumor (GvT), like GvL, will have a significant anti-tumoral effect. According to the literature, the feasibility of this procedure seems demonstrated. The fist available results in renal carcinomas are encouraging. However, the efficacy of this procedure remains uncertain for other potential indications. After presenting the published results, we will discussed the actual difficulties and the future potential developments.
Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , Doença Enxerto-Hospedeiro/imunologia , Humanos , Leucemia/terapia , Condicionamento Pré-Transplante/métodos , Imunologia de Transplantes , Transplante HomólogoRESUMO
A 33-year-old woman developed progressive ovarian cancer resistant to classical chemotherapy agents. We performed a bone marrow allograft after a myeloablative regimen. During hematological recovery, she developed acute graft-versus-host disease (GVHD). From this time her tumor diminished progressively. One year post transplant she has limited chronic liver GVHD and is still free of disease. The complete remission of advanced ovarian cancer was probably related to the GVHD which might therefore provide a new treatment option for this disease.
Assuntos
Adenocarcinoma Papilar/imunologia , Adenocarcinoma Papilar/terapia , Efeito Enxerto vs Tumor , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/terapia , Transplante Homólogo , Adenocarcinoma Papilar/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Comportamental , Transplante de Medula Óssea , Intervalo Livre de Doença , Resistência a Múltiplos Medicamentos , Feminino , Doença Enxerto-Hospedeiro , Humanos , Neoplasias Pulmonares/secundário , Neoplasias Ovarianas/patologiaRESUMO
There is a need for fast and sensitive methods to evaluate the response of patients with chronic myeloid leukaemia (CML) to interferon-alpha (IFN-alpha) therapy to complement cytogenetic analysis of Philadelphia (Ph) chromosome-positive metaphases. We have used interphase FISH (fluorescence in situ hybridization) and competitive RT-PCR (reverse transcriptase-polymerase chain reaction) techniques for detection of BCR-ABL-positive cells to measure suppression of leukaemic clone in a series of 51 follow-up samples from 24 CML patients undergoing IFN-alpha treatment. Interphase FISH analysis of the malignant clone in bone marrow using BCR and ABL probes was found to be highly correlated to conventional G-banding metaphase examination (r = 0.98). RT-PCR quantification of BCR-ABL mRNA transcripts in blood also showed a high degree of concordance with the proportion of Ph-positive metaphases (r = 0.93). In addition, the degree of cytogenetic response did not influence the equivalence between karyotype analysis and molecular methods. We concluded that interphase FISH and competitive RT-PCR provide reliable information on residual tumour burden and response to IFN-alpha in CML patients. These molecular methods may significantly improve the efficiency of residual disease monitoring during IFN-alpha therapy of CML.
Assuntos
Antineoplásicos/uso terapêutico , Hibridização in Situ Fluorescente/métodos , Interferon-alfa/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Reação em Cadeia da Polimerase/métodos , Feminino , Proteínas de Fusão bcr-abl , Humanos , Interfase , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Leucemia Mieloide de Fase Acelerada/patologia , Leucemia Mieloide de Fase Acelerada/terapia , Leucemia Mieloide de Fase Crônica/patologia , Leucemia Mieloide de Fase Crônica/terapia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Estudos Prospectivos , RNA Mensageiro/análise , Sensibilidade e EspecificidadeRESUMO
PURPOSE: A series of 53 patients with poor-prognosis epithelial ovarian cancer treated with high-dose chemotherapy (HDC) followed by hematopoietic rescue was retrospectively studied from the day of diagnosis for toxicity and long-term survival analysis. PATIENTS AND METHODS: Patients were treated with surgery followed by cisplatin combination chemotherapy. After second-look operation (SLO), HDC was administered: 23 patients received melphalan (140 mg/m2 on day 1) and 30 patients received a combination of carboplatin (400 mg/m2 on days 1 to 4) and cyclophosphamide (1.6 g/m2 on days 1 to 4). After HDC, autologous stem-cell transplantation was performed for hematologic support. RESULTS: One patient died of cardiac failure after HDC, but the acute toxicity was acceptable for the other patients. With a median follow-up of 81.5 months, the 5-year overall survival rate for the 53 patients was 59.9% and the disease-free survival (DFS) rate at 5 years was 23.6%. Twenty-four patients (45.3%) were alive, 12 with no evidence of disease and 12 with recurrent disease. The best results were achieved in 19 patients with pathologic complete response at SLO (74.2% 5-year overall survival; 32.8% 5-year DFS). CONCLUSION: HDC followed by autologous stem-cell support is a well-tolerated therapeutic approach for patients with poor-prognosis ovarian carcinoma. In this report, the 59.9% survival of 53 patients at 5 years must be compared to the 20% to 30% 5-year survival observed after conventional therapy. These results should be confirmed by an ongoing prospective randomized trial.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas , Neoplasias Ovarianas/tratamento farmacológico , Adulto , Antineoplásicos Alquilantes/administração & dosagem , Carboplatina/administração & dosagem , Carcinoma/patologia , Ciclofosfamida/administração & dosagem , Feminino , Humanos , Melfalan/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Prognóstico , Estudos Retrospectivos , Terapia de Salvação , Análise de Sobrevida , Resultado do TratamentoRESUMO
In this placebo-controlled randomized trial we evaluated the hematological and clinical effects of r-Hu GM-CSF after high-dose chemotherapy (HDC) followed by GM-CSF-mobilized PBPC transplantation. Fifty patients with poor prognosis malignancies were randomized in a double-blind study to receive either GM-CSF or placebo after HDC followed by PBPC rescue. For all patients, PBPCs were recruited using a combination of VP-16 (300 mg/m2 on days 1 and 2), cytoxan (3 g/m2 on days 3 and 4) and GM-CSF (5 micrograms/kg from day 5). No differences were demonstrated between the two groups in median time to neutrophil or platelet recoveries. There was no significant difference between the GM-CSF group and the placebo group in the median duration of post-transplant hospitalization, in the number of days of antibiotic treatment, in the number of infections and in red blood cell or platelet transfusion requirements. There was a significant difference with an advantage for the placebo group in the mean duration of febrile days (P = 0.01). We conclude that the administration of GM-CSF in patients transplanted with GM-CSF-mobilized PBPC is not associated with a clinical benefit in term of tempo of engraftment, numbers of documented infections, transfusion requirements and mucositis grading.