title: Combinations of 4-hydroperoxycyclophosphamide (4-HC) and cisplatin for bone marrow purging in autologous marrow transplantation: an update.
abstract: We are studying the usefulness of combinations of 4-HC and cisplatin as a potential purging regimen for autologous bone marrow transplantation. In all of our studies, in vitro cytotoxicity was determined by clonogenic assay, and drug interaction was quantitated using the multiple drug-effect analysis method. The cells were incubated for one hour (4-HC) and/or 4 hours (cisplatin). We found that the drugs in combination had cytotoxic synergism against human leukemia cell lines (K-562 and Raji). The synergism was sequence-dependent (cells must be exposed to 4-HC first), was present at various molar ratios of the drugs, and most pronounced at high levels of cell kill. We also found that the drugs had cytotoxic synergism against normal human marrow progenitors (CFU-GM). However, the leukemic cells were approximately 55 times more sensitive to the combination than CFU-GM. In a murine system, the drugs were synergistic against L1210 leukemia cells and normal murine CFU-GM, but L1210 cells were at least 130 times more sensitive to the combination than CFU-GM. To determine the ability of L1210 cells to grow in vivo after exposure to the drugs, BDF1 mice were injected with 2 x 10(4) cells which had been incubated with 4-HC and/or cisplatin. The survival time of untreated controls was 13 +/- 2.8 days. For treated groups, the cure rates after 50 days of observation were 33% (4-HC, 40 uM), 0% (cisplatin, 8 uM), and 100% (4-HC + cisplatin). Finally, at concentrations resulting in equivalent toxicity to marrow CFU-GM, cisplatin seemed to be more toxic to murine spleen blast colony forming cells (CFC-BC) than 4-HC. The drugs in combination appeared to have at least additive toxicities against CFC-BC.
authors.affiliation: Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Veterans Administration Hospital, Charleston, South Carolina 29425.
authors.forename: R H
authors.initials: RH
authors.lastname: Peters
authors.forename: C S
authors.initials: CS
authors.lastname: Brandon
authors.forename: L A
authors.initials: LA
authors.lastname: Avila
authors.forename: G R
authors.initials: GR
authors.lastname: Gale
authors.forename: R K
authors.initials: RK
authors.lastname: Stuart
mesh_terms: D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001853:Bone Marrow / Q000187:drug effects*; D001854:Bone Marrow Cells; D016026:Bone Marrow Transplantation / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000031:analogs & derivatives; D004357:Drug Synergism; D006801:Humans; D007939:Leukemia L1210 / Q000628:therapy; D008213:Lymphocyte Activation / Q000187:drug effects; D008297:Male; D051379:Mice; D013154:Spleen / Q000166:cytology / Q000187:drug effects; D013234:Stem Cells / Q000187:drug effects; D014182:Transplantation, Autologous; D014407:Tumor Cells, Cultured
chemical_list: D003520:Cyclophosphamide; D002945:Cisplatin; C011272:perfosfamide