Regimen-related toxicity after fludarabine–melphalan conditioning: a prospective study of 31 patients with hematologic malignancies
| Autor: | K. Van Besien, R. Hoffman, K. Amin, David Peace, J. Sossman, Y. H. Chen, S. Devine, F. Ravandi, E. Jessop, Wendy Stock, M. Yassine, V. Maynard, Amittha Wickrema |
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| Rok vydání: | 2003 |
| Předmět: |
Melphalan
medicine.medical_specialty Transplantation Conditioning Pulmonary toxicity medicine.medical_treatment Graft vs Host Disease Hematopoietic stem cell transplantation Gastroenterology Disease-Free Survival Internal medicine Antineoplastic Combined Chemotherapy Protocols Humans Transplantation Homologous Medicine Transplantation business.industry Siblings Graft Survival Hematopoietic Stem Cell Transplantation Hematology Surgery Fludarabine Regimen Hematologic Neoplasms Toxicity business Vidarabine medicine.drug |
| Zdroj: | Bone Marrow Transplantation. 32:471-476 |
| ISSN: | 1476-5365 0268-3369 |
| DOI: | 10.1038/sj.bmt.1704166 |
| Popis: | A total of 31 consecutive patients with hematologic malignancies who were considered poor candidates for TBI underwent allogeneic stem cell transplantation after conditioning with fludarabine and melphalan. A total of 25 matched sibling recipients received fludarabine 25 mg/m(2) x 5 days and melphalan 70 mg/m(2) x 2 days. For unrelated and haploidentical donor recipients, fludarabine was increased to 30 mg/m(2) and ATG 30 mg/kg x 4 days was added. Graft-versus-host disease prophylaxis consisted of tacrolimus and mini methotrexate. All patients engrafted. Regimen-related toxicity was considerable and included mainly renal, hepatic and mucosal toxicity. There were seven regimen-related-deaths including two VOD, two pulmonary, one renal, one cardiac and one mucosal toxicity. One case of fatal pulmonary toxicity death could be attributed to pre-existing pulmonary damage. Progression-free survival at 12 months was 44% (90% CI: 30-58%) for recipients of HLA-identical sibling transplants and 33% (90% CI: 21-45%) for all patients. In conclusion, the fludarabine-melphalan regimen leads to consistent engraftment. The regimen-related toxicity is considerable and cannot be explained solely by patient selection. Cardiac toxicity is emerging as a unique toxicity of this regimen. Despite toxicity, fludarabine-melphalan has considerable activity and leads to durable remission in a proportion of patients. |
| Databáze: | OpenAIRE |
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