Toxicity Associated With High-dose Cytosine Arabinoside And Total Body Irradiation As Conditioning For Allogeneic Bone Marrow Transplantation

Toxicity Associated With High-dose Cytosine Arabinoside And Total Body Irradiation As Conditioning For Allogeneic Bone Marrow Transplantation

Kumar M; Saleh A; Rao P V; Ochoa S; Meyers L; Miller A; GrahamPole J

Bone Marrow Transplantation

1997

1997-06

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/m(2) 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-versushost 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 GVHD and sepsis rates seen in certain categories of patients indicate a need for careful definition of eligibility criteria for this still highly toxic treatment.

acute lymphoblastic-leukemia; adults; allogeneic; Biophysics; children; cyclophosphamide; cytosine; hematologic; Hematology; Immunology; lymphoma; malignancies; Oncology; preparative regimen; remission; survival; therapy; total body irradiation; toxicity; transplantation; transplantation

Journal Article or Conference Abstract Publication

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1061-1064

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