5c Autologous haemotherapy in malignant diseases

Pre-donation of blood in cancer patients is effective and recommendable, but is limited by tumour anaemia, urgent scheduling of surgery and variable blood loss resulting in discarded autologous blood or homologous transfusions. Intra-operative autotransfusion is considered to be contraindicated in cancer surgery. This was confirmed by the recent demonstration of the frequent existence of vital, proliferating, invasive and tumorigenic tumour cells in high numbers in the blood shed during surgery of various cancers. Leukocyte depletion filters are unable to guarantee complete elimination of contaminating tumour cells because of the limited reduction rates. The radiosensitivity of the nucleated tumour cells, in contrast to the radioresistance of the unnucleated red blood cells, can be used for efficient elimination. For 50 Gy a 12 decade reduction can be calculated from radiosensitivity data, and experimentally a 10 decade reduction has been demonstrated, sufficient to eliminate any supposed tumour cell contamination. This combination of two well-established methods, intra-operative blood salvage and blood irradiation, in clinical practice proved to be an effective, practical and safe procedure for using autologous blood in cancer patients.