title: A phase I-II study of high-dose thiotepa, busulfan and cyclophosphamide as a preparative regimen for autologous transplantation for malignant lymphoma.
abstract: Thirty-four adults with malignant lymphoma at high-risk for relapse were treated on a Phase I-II study of high-dose thiotepa (THIO), busulfan (BU) and cyclophosphamide (CYC) with autologous marrow or peripheral blood stem cell support. Four patients were in untreated relapse, 7 had stable or progressive disease, 12 were in partial remission, and 11 were in complete remission after reinduction chemotherapy before proceeding to the preparative regimen. Median follow-up time is 22 months. Grades 3-4 regimen-related toxicity occurred in 3 (14%) of 22 patients treated with THIO 250 mg/m2 x 3, BU 1 mg/kg x 10 and CYC 50 mg/kg x 3, and this was considered the maximal tolerated dose-schedule. Of the 23 patients with active disease at the time of transplantation, 52% (95% CI 31-73%) achieved a complete response, and 26% (95% CI 10-48%) achieved a partial response. For all patients, median time to progression was 13 months, median survival was 16 months, and disease-free survival at 18 months was 34% (95% CI 18-51%). The combination of THIO, BU and CYC is tolerable as a preparative regimen for lymphoma and has a high response rate, but further measures are needed to reduce the relapse rate for patients with advanced disease.
authors.affiliation: Section of Bone Marrow Transplantation, University of Texas M. D. Anderson Cancer Center, Houston, USA.
authors.forename: D
authors.initials: D
authors.lastname: Przepiorka
authors.forename: R
authors.initials: R
authors.lastname: Nath
authors.forename: C
authors.initials: C
authors.lastname: Ippoliti
authors.forename: R
authors.initials: R
authors.lastname: Mehra
authors.forename: F
authors.initials: F
authors.lastname: Hagemeister
authors.forename: K
authors.initials: K
authors.lastname: Diener
authors.forename: M
authors.initials: M
authors.lastname: Dimopoulos
authors.forename: S
authors.initials: S
authors.lastname: Giralt
authors.forename: I
authors.initials: I
authors.lastname: Khouri
authors.forename: B
authors.initials: B
authors.lastname: Samuels
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000008:administration & dosage; D056486:Chemical and Drug Induced Liver Injury; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D013852:Thiotepa / Q000008:administration & dosage; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D003520:Cyclophosphamide; D013852:Thiotepa; D002066:Busulfan