Autotransplantation following busulfan, etoposide and cyclophosphamide in patients with non-Hodgkin's lymphoma

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Obesity continues to be an increasing global health issue contributing to the complexity of chemotherapy dosing in the field of SCT. Investigation into the optimal dosing weight used to calculate chemotherapy doses in obese patients undergoing SCT is limited and inconclusive. Our single-center, retrospective study compared safety and efficacy outcomes by body mass index (BMI) for 476 adult lymphoma patients who underwent auto-SCT with a myeloablative chemotherapeutic regimen of BU, CY and etoposide dosed using adjusted body weight. Three weight groups categorized based on BMI were defined: normal/underweight ⩽ 24.9 kg/m 2 , overweight 25-29.9 kg/m 2 and obese ⩾ 30 kg/m 2 . Severity of mucositis, incidence of secondary malignancy, incidence of bacteremia and median hospital length of stay did not differ among the groups. The median times to absolute neutrophil count and platelet recovery were 10 days (P = 0.75) and 14 days (P = 0.17), respectively. Obese patients had a lower 100-day mortality compared with other weight groups, although this did not translate into an OS benefit. OS and disease relapse were similar among the groups. Our study demonstrates that use of adjusted body weight to calculate chemotherapy doses does not negatively have an impact on outcomes in obese patients undergoing auto-SCT with BU, CY and etoposide.

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Outcomes after autologous SCT in lymphoma patients grouped by weight

Lau

Weber

Earl

et al. 2015

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“…However, the addition of etoposide has not been demonstrated to offer an advantage when added to Bu/cyclophosphamide in patients with leukemias in a prospective study. Studies in adults with leukemias and lymphomas have noted an increase in hepatotoxicity, including veno-occlusive disease (VOD), dermatologic toxicity, and mucositis, [22][23][24][25] without an increase in treatment-related mortality.…”

Section: Discussionmentioning

confidence: 99%

Randomized trial of busulfan vs total body irradiation containing conditioning regimens for children with acute lymphoblastic leukemia: A Pediatric Blood and Marrow Transplant Consortium study

Bunin

Aplenc

Kamani

et al. 2003

187

116

Summary:Conditioning regimens for children with ALL have generally included total body irradation (TBI), which may result in significant sequelae. The primary aim of this study was to evaluate the outcome for children with ALL undergoing allogeneic stem cell transplant (SCT) with either busulfan (Bu) or TBI regimens. Patients o21 years with ALL undergoing allogeneic SCT were eligible. Conditioning included either Bu or TBI, with etoposide 40 mg/kg and cyclophosphamide 120 mg/kg. Randomization was stratified based upon duration of remission, remission status, and prior cranial irradiation. A total of 43 patients were enrolled; 21 received Bu and 22 TBI. Median patient age was 8 years (0.5-20 years). Remission status included 12 patients in CR1, 25 in CR2, and six in CR3. At a median follow-up of 43 months, event-free survival (EFS) is 45% at 3 years, with 29% EFS in the Bu arm and 58% in the TBI arm (P ¼ 0.03). There was no significant difference between Bu and TBI for patients who received stem cells from related donors (36 vs 58%, P ¼ 0.3). However, for URD, EFS was 20% for Bu and 57% for TBI (P ¼ 0.04). Relapses were similar in both arms. This randomized prospective study suggests that Bu is inferior to TBI for pediatric patients with ALL undergoing allogeneic SCT.

“…The details of administration and supportive care have been previously described. 15 G-CSF was administered to all patients to accelerate neutrophil recovery beginning on either the day following stem cell infusion or 5 days following infusion. 16 Follow-up Following auto-HCT, patients were followed either at the Cleveland Clinic or at their local oncologist's office.…”

Section: Preparative Regimensmentioning

confidence: 99%

Fludarabine as a risk factor for poor stem cell harvest, treatment-related MDS and AML in follicular lymphoma patients after autologous hematopoietic cell transplantation

Waterman

Rybicki

Bolwell

et al. 2011

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Fludarabine is an effective treatment for follicular lymphoma (FL), but exposure to it negatively impacts stem cell mobilization and may increase the risk of subsequent myelodysplastic syndrome and acute myelogenous leukemia (t-MDS/AML). We hypothesized that the risk that fludarabine imparts to stem cell mobilization and t-MDS/AML would be affected by dose or timing. All patients with FL treated at Cleveland Clinic from 1991 to 2007 with autologous hematopoietic cell transplantation were evaluated. Recursive partitioning analysis was used to explore associations of fludarabine and mitoxantrone dose and timing with poor stem cell harvest and t-MDS/ AML. We identified 171 patients, of whom 52 previously received fludarabine. Patients exposed to fludarabine prior to auto-HCT were more likely to require 45 days of leukapheresis (Po0.001) and second stem cell mobilization (Po0.001), especially at a cumulative dose 4150 mg/m 2 . Univariable risk factors for t-MDS/AML included the number of chemotherapy regimens before auto-HCT, the need for 45 days of leukapheresis to collect CD34 þ cells and fludarabine exposure in a dosedependent manner, particularly when 4500 mg/m 2 . A cumulative dose of fludarabine 4150 mg/m 2 increases the risk for poor stem cell harvests and any exposure increases the risk of t-MDS/AML, with the greatest risk being at doses 4500 mg/m 2 .