The psychosocial experience of women treated for breast cancer by high-dose chemotherapy supported by autologous stem cell transplant: a qualitative analysis of support groups.

Autologous bone marrow transplantation (AuBMT) is probably among the most aggressive of physical treatments endured by cancer patients. High-risk breast cancer patients who choose this therapy face prolonged, agonizing and life-threatening interventions that are no less arduous than confronting the malignant disease itself. The study, which aimed to broadening our understanding of the psychosocial impact and the implications of AuBMT, presents a protocol analysis of group support intervention in 45 recipients (eight to ten women in five groups). The sessions were held at the Transplant Department at the Chaim Sheba Medical Center. The contribution of group support to the healing process was examined. The findings show that recovery was affected by a wide range of psychosocial factors, specifically highlighting the impact of transplantation and survival on five domains, viz. physical, psychological/emotional, vocational, social and family/spousal intimacy. Illness and treatment management is also discussed. The support generated by the group, both individually and collectively, was found to contribute significantly to the spectrum of resources available to the participants.

Enhanced marrow recovery by short preincubation of marrow allografts with human recombinant interleukin-3 and granulocyte-macrophage colony-stimulating factor.

We studied an alternative method of using hematopoietic growth factors (HGFs) to enhance hematopoietic recovery in patients undergoing bone marrow transplantation (BMT), by short in vitro preincubation. Twenty consecutive patients with leukemia received T-cell-depleted allografts using Campath-1G. Two thirds of the marrow was infused on the scheduled day of transplant and one third of the marrow following preincubation with granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-3 (IL-3) on day 4. Engraftment parameters and duration of hospitalization were compared by actuarial analysis to those of 40 historical controls. Patients receiving the incubated boost had significantly faster platelet recovery (P = .017) and shorter hospitalization period (P = .001) when compared with the control subjects. Platelet count reached greater than 25 x 10(9)/L on day 17 (median) in the study group and on day 23 in the controls. The median duration of hospitalization was 20 and 36 days, respectively. In the early posttransplantation follow-up, two of four patients in the study group died as a result of graft rejection, while all 13 deaths in the control group resulted from complications associated with marrow suppression. We suggest that pretransplant in vitro activation of bone marrow cells with IL-3 and GM-CSF may prove to be an efficient method for enhancing marrow recovery after BMT.