Document Detail

The toxicity of busulphan and cyclophosphamide as the preparative regimen for bone marrow transplantation.
MedLine Citation:
PMID:  2025579     Owner:  NLM     Status:  MEDLINE    
The toxicity of the conditioning regimen of high dose busulphan (Bu) (16 mg/kg) and cyclophosphamide (Cy) (120 mg/kg) has been compared to cyclophosphamide (Cy) (120 mg/kg) and fractionated total body irradiation (TBI) 12-14 Gy. Since 1985, 67 patients have received conditioning of Bu and Cy for HLA-identical sibling bone marrow transplants. 166 patients have received Cy and TBI since 1981. Veno-occlusive disease of the liver occurred in 19% in the Bu-Cy group and was fatal in 1/12 cases, but only in 1.3% of Cy-TBI group (P less than 0.0005) and was fatal in 1/2. 30% of evaluable patients developed haemorrhagic cystitis in the Bu-Cy group and 14% in the Cy-TBI group (P = 0.008). A multiple logistic regression analysis demonstrated the preparative regimen as the only significant risk factor for the development of veno-occlusive disease or haemorrhagic cystitis. Interstitial pneumonia was diagnosed in 12/56 evaluable patients (21%) in the Bu-Cy group and was fatal in 75%. It occurred in 39/137 evaluable patients (28%) in the Cy-TBI group with a 54% case mortality. Within the Bu-Cy group, the incidence of veno-occlusive disease and haemorrhagic cystitis was similar in chronic myeloid leukaemia (CML) and acute leukaemia (AL) groups, but there was a significant (P = 0.003) incidence of interstitial pneumonia in the CML group 36% as compared to 7% in the AL group. Preparative regimen and age were significant risk factors in the development of interstitial pneumonia in patients with CML. A flexural and acral rash ranging from pigmentation to severe erosion was noted in the Bu-Cy group, but not in the Cy-TBI group. Thus, veno-occlusive disease, haemorrhagic cystitis and cutaneous changes were more common in patients receiving Bu-Cy. Interstitial pneumonia was more common in patients receiving Bu-Cy for CML than for AL.
M Morgan; A Dodds; K Atkinson; J Szer; K Downs; J Biggs
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  British journal of haematology     Volume:  77     ISSN:  0007-1048     ISO Abbreviation:  Br. J. Haematol.     Publication Date:  1991 Apr 
Date Detail:
Created Date:  1991-06-12     Completed Date:  1991-06-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372544     Medline TA:  Br J Haematol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  529-34     Citation Subset:  IM    
Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia.
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MeSH Terms
Bone Marrow Transplantation*
Busulfan / adverse effects*
Cyclophosphamide / adverse effects*
Cystitis / chemically induced
Drug Therapy, Combination
Hematuria / chemically induced
Hepatic Veno-Occlusive Disease / chemically induced
Leukemia / surgery*
Middle Aged
Preoperative Care / adverse effects*
Pulmonary Fibrosis / chemically induced
Whole-Body Irradiation / adverse effects
Reg. No./Substance:
50-18-0/Cyclophosphamide; 55-98-1/Busulfan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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