| Fractionated total-body irradiation, etoposide, and cyclophosphamide followed by allogeneic bone marrow transplantation for patients with high-risk or advanced-stage hematological malignancies. | |
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MedLine Citation:
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PMID: 9502300 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Myeloablative therapy followed by allogeneic bone marrow transplantation (BMT) has proven to be curative therapy in patients with hematologic malignancies. Relapse, however, remains a major cause of treatment failure for patients with advanced disease. During the past 15 years, we have gained considerable experience with the combination of fractionated total-body irradiation (FTBI) and etoposide followed by allogeneic BMT for hematologic malignancies. In an attempt to decrease post-transplant relapse rates, 67 patients under the age of 50 years with high-risk or advanced-stage hematological malignancies received an intensified regimen of FTBI and etoposide plus cyclophosphamide followed by BMT from a genotypically-matched related donor. The regimen consisted of 1320 cGy of FTBI in 11 fractions, 60 mg/kg of etoposide (VP-16), and 60 mg/kg of cyclophosphamide (CY). Fifty-three patients received cyclosporine and prednisone for graft-vs.-host disease (GVHD) prophylaxis and 14 patients received cyclosporine, methotrexate, and prednisone. Diagnosis at BMT included 45 patients with acute leukemia, 7 patients with chronic leukemia, and 15 patients with high-grade non-Hodgkin's lymphoma (NHL). Actuarial disease-free survival (DFS) at 3 years was 42% +/- 12% for the entire group with a median follow-up of 50 months (range 20-74) for 28 patients who remain alive in continued complete remission (CR). Actuarial 3-year-DFS was 38% +/- 14% in 52 patients with acute or chronic leukemia and 60% +/- 25% in 15 patients with NHL with relapse rates of 45% +/- 16% and 21% +/- 11%, respectively. DFS at 3 years was 40% +/- 18% in 32 patients with acute leukemia in 1st relapse or 2nd CR or chronic myelogenous leukemia in accelerated phase, and was 32% +/- 22% in 20 patients with more advanced disease. Regimen related mortality occurred in 9 patients (4, veno-occlusive disease of the liver; 2, multi-organ failure; 1, diffuse alveolar hemorrhage; 1, central nervous system (CNS) hemorrhage; 1, adult respiratory distress syndrome (ARDS). The combination of FTBI, etoposide, and cyclophosphamide followed by allogeneic BMT is an effective and relatively well-tolerated regimen for patients with advanced hematologic malignancies. The role for this regimen should be further defined by prospective clinical trials. |
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Authors:
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G D Long; M D Amylon; K E Stockerl-Goldstein; R S Negrin; N J Chao; W W Hu; A P Nademanee; D S Snyder; R T Hoppe; N Vora; R Wong; J Niland; V L Reichardt; S J Forman; K G Blume |
Publication Detail:
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Type: Clinical Trial; Clinical Trial, Phase II; Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation Volume: 3 ISSN: 1083-8791 ISO Abbreviation: Biol. Blood Marrow Transplant. Publication Date: 1997 Dec |
Date Detail:
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Created Date: 1998-05-08 Completed Date: 1998-05-08 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 9600628 Medline TA: Biol Blood Marrow Transplant Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 324-30 Citation Subset: IM |
Affiliation:
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Department of Medicine, Stanford University Medical Center, CA, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Antineoplastic Agents, Alkylating / therapeutic use* Antineoplastic Agents, Phytogenic / therapeutic use* Antineoplastic Combined Chemotherapy Protocols / therapeutic use* Bone Marrow Transplantation* Child Combined Modality Therapy Cyclophosphamide / therapeutic use* Disease-Free Survival Etoposide / therapeutic use* Female Graft vs Host Disease / etiology, mortality Hematologic Neoplasms / therapy* Humans Male Middle Aged Whole-Body Irradiation |
| Grant Support | |
ID/Acronym/Agency:
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CA 2PO1 30206/CA/NCI NIH HHS; CA 2PO1 49605/CA/NCI NIH HHS; CA33572/CA/NCI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antineoplastic Agents, Alkylating; 0/Antineoplastic Agents, Phytogenic; 33419-42-0/Etoposide; 50-18-0/Cyclophosphamide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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