[High dose chemotherapy with autologous stem cell transplantation]

Subsequent stem cell transplantation makes it possible to increase the dose of oncological chemotherapy by a factor of between three- and ten-fold. For primary treatment, the superiority of this approach vis-a-vis standard doses seems to be highly likely in the case of recurrent highly malignant lymphomas, metastatic mamma carcinomas and plasmacytomas. To date, however, the most favorable time point for high-dose chemotherapy has not yet been definitively established-not has the patient group most likely to benefit or the most effective combination of cytostatics to be used. For this reason, such treatment, even of these diseases, should not be applied outside of controlled studies, and must be viewed even more critically in the case of other diseases for which data from randomized studies are not yet available. Despite a relatively low overall level of toxicity, peripheral blood stem cell transplantation (PBSCT) still has a mortality rate--even in large centers--of 2 to 5%. Any such treatment should therefore be given only in controlled studies and in suitable centers.