ABSTRACT
There is now substantial evidence supporting the role of high-dose chemotherapy prior to peripheral blood stem-cell transplant (PBSCT) or bone-marrow transplant (BMT) in the management of leukaemias [1], lymphomas [2] and some solid tumours, e.g. testicular carcinoma and neuroblastoma [3]. Historically, alkylating agents were the first cytotoxic drugs to be used in high dose as either single agents or in combination with other alkylating agents, because their major dose-limiting toxicity is myelosuppression. Chemotherapeutic drugs now used in high-dose protocols include the alkylating agents cyclophosphamide, ifosfamide, melphalan, carmustine, busulphan, carboplatin, cisplatin and thiotepa. Non-alkylating agents include etoposide, cytosine arabinoside, methotrexate and paclitaxel. The optimal use of cytotoxic drugs has been fundamental to progress in cancer chemotherapy in recent years and this chapter will explain the importance of dose and schedule.
