Efficacy of etoposide, cyclophosphamide, and total body irradiation in allogeneic bone marrow transplantation for adult patients with hematological malignancies

• Published in: Clinical transplantation Vol. 18; no. 5; pp. 552 - 557
• Main Authors: Toubai, Tomomi, Tanaka, Junji, Mori, Akio, Hashino, Satoshi, Kobayashi, Sumiko, Ota, Shuichi, Miura, Yoko, Kato, Naoko, Kahata, Kaoru, Izumiyama, Ko, Yonezumi, Masakatu, Chiba, Koji, Kondo, Takeshi, Toyoshima, Nobuyasu, Asaka, Masahiro, Imamura, Masahiro
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01-10-2004; Blackwell
• Subjects: Adolescent; Adult; allogeneic bone marrow transplantation; Antineoplastic Agents, Phytogenic - administration & dosage; Antineoplastic Agents, Phytogenic - therapeutic use; Biological and medical sciences; Bone Marrow Transplantation; Cardiology. Vascular system; Cause of Death; cyclophosphamide; Cyclophosphamide - therapeutic use; Disease-Free Survival; etoposide (VP-16); Etoposide - administration & dosage; Etoposide - therapeutic use; Female; Follow-Up Studies; General aspects; Graft Survival; Graft vs Host Disease - prevention & control; Hematologic Neoplasms - therapy; hematological malignancies; Humans; Immunosuppressive Agents - therapeutic use; Male; Medical sciences; Middle Aged; preconditioning regimen; Remission Induction; Retrospective Studies; Safety; Survival Rate; total body irradiation; Transplantation Conditioning; Treatment Outcome; Whole-Body Irradiation; Antineoplastic agent; Stem cell; Hematopoietic cell; Homograft; allogeneic bone marrow transplantation; Isomerases; Efficiency; Bone marrow; Graft; Adult; Anesthesia; Cardiology; Antimitotic; Human; hematological malignancies; DNA topoisomerase (ATP-hydrolysing); Total body irradiation; Enzyme; Enzyme inhibitor; Etoposide; Malignant hemopathy; Podophyllotoxine derivatives; etoposide (VP-16); Alkylating agent; Oxazaphosphinane derivatives; Cyclophosphamide; Nitrogen mustard; preconditioning regimen; Circulatory system; Immunosuppressive agent; Preconditioning
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2004.00225.x

:  Introduction:  A combination of fractionated total body irradiation (TBI) with etoposide (VP‐16) and cyclophosphamide (CY) as a preconditioning regimen (VP/CY/TBI) has been reported to be safe and effective for both adults and children undergoing allogeneic bone marrow transplantation (allo‐BMT). However, the reported doses of VP‐16 were different. We evaluated the efficacy and safety of a VP‐16 (at less than the usual dose)/CY/TBI regimen for adults with hematological malignancies who are required to receive allo‐BMT.
Patients and methods:  Thirty‐eight patients received VP‐16, CY and TBI (VP/CY/TBI) as a preconditioning regimen for allo‐BMT. Twenty‐one patients were in first complete remission (1CR), six patients were in second remission (2CR) and 11 patients were in non‐remission status (non‐CR) before allo‐BMT. These patients received allo‐BMT from related donors (n = 14) and unrelated donors (n = 24). The preconditioning regimen consisted of VP‐16 (15 mg/kg/d for 2 d), CY (60 mg/kg/d for 2 d) and 12 Gy TBI in six fractions for 3 d.
Results:  Two patients died on day 30 after transplantation. The median follow‐up period for all patients was 35.0 months (range 0.8–159.6 months). At the time of analysis, 10 patients had died. Seven of those 10 patients died because of relapse. The estimated 5‐yr disease‐free survival (DFS) rates for all cases and acute myelogenous leukemia and acute lymphoblastic leukemia cases were 73.6, 66.7 and 100%, respectively. The estimated 5‐yr DFS rates for 1CR, 2CR and non‐CR cases were 90.5, 83.3 and 40.9%, respectively (p < 0.05).
Conclusion:  Based on these findings, we suggest that a VP/CY/TBI regimen is effective and safe for adult patients with hematological malignancies in 1CR and 2CR.