Seventeen patients with advanced malignancies received escalating doses of chemotherapy with adriamycin and cyclophosphamide. Sixty-five per cent of the courses produced circulating granulocyte counts of 500 cells/mm3 or less. Febrile episodes occurred in only 15% of courses and were seen only with doses of chemotherapy that produced granulocyte nadirs of less than 200 cells/mm3. There were no episodes of septicaemia. Ten of the 17 patients received an intensive dose followed by reinfusion of cryopreserved, autologous bone marrow. In 5 of these patients, recovery to 500 granulocytes/mm3 was more rapid following the intensive, marrow-supported course by comparison with the prior, less intensive, unsupported course. We conclude that higher doses of adriamycin and cyclophosphamide than are conventionally used can be given without serious toxicity. Autologous bone marrow reinfusion may have a role in reducing the period of drug-induced granulocytopenia, but effective storage and recovery of human bone marrow remains a major problem.
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