Dose-dependent effect of etoposide in combination with busulfan plus cyclophosphamide as conditioning for stem cell transplantation in patients with acute myeloid leukemia
| Autor: | U. Mayer, N Stute, Tatjana Zabelina, H Renges, A R Zander, S Sonnenberg, W Krüger, Walter Fiedler, Hartmut Kabisch, N Kröger, R. Sonnen, F. del Valle, R. Kuse, F. Finkenstein, K. Holstein, D Braumann, Bernd Metzner, H. Colberg, Rudolf Erttmann |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Blood Platelets Male medicine.medical_specialty Transplantation Conditioning Adolescent Cyclophosphamide medicine.medical_treatment Graft vs Host Disease Gastroenterology Disease-Free Survival Recurrence Internal medicine Antineoplastic Combined Chemotherapy Protocols Leukocytes medicine Mucositis Humans Child Busulfan Etoposide Transplantation Chemotherapy Dose-Response Relationship Drug business.industry Graft Survival Hematopoietic Stem Cell Transplantation Infant Hematology Middle Aged medicine.disease Surgery Survival Rate Leukemia Treatment Outcome medicine.anatomical_structure Leukemia Myeloid Child Preschool Acute Disease Drug Evaluation Female Bone marrow business Follow-Up Studies medicine.drug |
| Zdroj: | Bone Marrow Transplantation. 26:711-716 |
| ISSN: | 1476-5365 0268-3369 |
| DOI: | 10.1038/sj.bmt.1702598 |
| Popis: | To evaluate the efficacy and toxicity of two different etoposide (VP-16) dosages (30 or 45 mg/kg) in combination with busulfan/cyclophosphamide as conditioning therapy followed by stem cell transplantation in acute myeloid leukemia (AML), 90 patients with AML received either 30 mg/kg (n = 60) or 45 mg/kg (n = 30) etoposide in combination with busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg). The stem cell source was allogeneic related bone marrow (BM) (n = 53), allogeneic unrelated BM (n = 5), allogeneic unrelated peripheral blood (PBSC) (n = 2), syngeneic BM (n = 2), autologous BM purged (n = 9) or unpurged (n = 9), autologous PBSC (n = 10). Fifty-six patients (62%) were in first CR, 26 (29%) were > first CR, and eight (9%) were transplanted in relapse. Principal toxicities in both groups were mucositis and hepatotoxicity. Forty-five mg/kg etoposide resulted in greater hepatic toxicity (P = 0.03), and a higher incidence of VOD (23 vs 12%, P = 0.04) and acute GVHD grade III/IV (13 vs 5%, NS). The treatment-related mortality was 17% in the 30 mg/kg group and 33% in the 45 mg/kg group, mainly due to infections, intestinal pneumonia and GVHD. Hematological recovery of leukocytes 1/nl was comparable in both groups (17 vs 16 days). After a median follow-up of 16 months 19% in the 30 mg/kg group and 23% in the 45 mg/kg group relapsed. In patients who had undergone allogeneic related bone marrow transplantation in first CR no relapses occurred after a median follow-up of 3 years. For all patients the 3-year estimated disease-free survival was 62% in the 30 mg/kg group and 40% in the 45 mg/kg group (P = 0.03). For patients in first CR who underwent allogeneic related stem cell transplantation the 3 year disease-free survivals were 80% and 66%, respectively (P = 0.4). We conclude that etoposide 30 mg/kg or 45 mg/kg in combination with busulfan/cyclophosphamide is a highly active regimen for bone marrow transplantation of patients with AML with a low relapse rate. However, conditioning with 30 mg/kg rather than 45 mg/kg etoposide resulted in less toxicity and a better overall survival due to a lower transplant-related mortality. Bone Marrow Transplantation (2000) 26, 711-716. |
| Databáze: | OpenAIRE |
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