Prevention of leukemic relapse after transplantation with lymphocyte depleted marrow by intensification of the conditioning regimen with a 6-day continuous infusion of anthracyclines.
In the present study we have evaluated the efficacy and toxicity of a 6-day continuous constant rate intravenous infusion of anthracyclines added to the standard conditioning regimen for allogeneic bone marrow transplantation (BMT). In 22 consecutive recipients of a lymphocyte depleted bone marrow graft, either demethoxydaunomycin (n = 11) or daunorubicin (n = 11) were added to high-dose cyclophosphamide and total body irradiation. Five patients had acute non-lymphoblastic leukemia in first complete remission, six patients acute lymphoblastic leukemia in first or second complete remission, nine patients chronic myelogenous leukemia in chronic phase and two patients refractory anemia with excess of blasts. After a median observation period of 18 months, only one leukemic relapse has been observed. Six patients died in the post-transplant period. In 17 of the 22 patients a severe, transient mucositis developed. No cardiac toxicity, as assessed with radioisotope studies, was observed. We conclude that anthracyclines may be effectively and safely incorporated in conditioning regimens before BMT, provided that they are administered as long-term continuous infusions in order to avoid toxicity due to excessive plasma levels.
Raemaekers
J
J
Department of Medicine, University Hospital Nijmegen, The Netherlands.
De Witte
T
T
Schattenberg
A
A
Van der Lely
N
N
D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology; D016026:Bone Marrow Transplantation; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007938:Leukemia / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D007958:Leukocyte Count / Q000187:drug effects; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D010976:Platelet Count / Q000187:drug effects; D011292:Premedication / Q000379:methods; D012008:Recurrence
D000903:Antibiotics, Antineoplastic