Toxicity associated with high-dose cytosine arabinoside and total body irradiation as conditioning for allogeneic bone marrow transplantation

Bone Marrow Transplantation
M KumarJ Graham-Pole

Abstract

Seventy-three patients with hematological cancers undergoing allogeneic bone marrow transplantation (BMT) were evaluated for event-free survival (EFS) and toxicity. All received 36 g/m2 cytosine arabinoside (HDA) and 1200 cGy fractionated total body irradiation (TBI). We assessed the association of EFS and toxicities with the following risk factors; age, gender, diagnosis, initial relapse risk and patient-donor histocompatibility. The EFS probability is 33% at 800 days post-BMT. Twenty-six patients (36%) died of toxicity within 100 days and 14 (19%) have relapsed. EFS was inversely associated with age (P < 0.0001) and initial relapse risk (P = 0.007). The risk of pulmonary (P = 0.023) and hepatic toxicity (P = 0.011) increased with age. Diagnosis other than acute lymphoblastic leukemia (ALL) was a risk factor (P = 0.015) for graft-versus-host disease (GVHD); and fewer ALL patients died from toxicity (P = 0.014). The probability of sepsis within 100 days post-BMT correlated (P = 0.007) with initial relapse risk. We conclude: (1) the lower EFS and greater pulmonary and hepatic toxicity associated with increasing age indicate a need for less toxic regimens that maintain high antileukemic efficacy for older patients; (2) the high G...Continue Reading

Citations

Feb 26, 1998·Leukemia & Lymphoma·B A Pierson, J S Miller
Jul 22, 2008·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Masaya OkadaHiroyasu Ogawa
Nov 30, 2014·International Journal of Clinical Pharmacy·Xiaojin CaiSizhou Feng
Sep 10, 2003·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Philip J BiermanUNKNOWN Lymphoma Working Committee of the International Bone Marrow Transplant Registry and the European Group for Blood and Marrow
Sep 21, 2004·Springer Seminars in Immunopathology·Franco Aversa, Massimo F Martelli

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