title: High-dose carmustine, etoposide and melphalan ('BEM') with autologous stem cell transplantation: a dose-toxicity study.
abstract: We have investigated the toxicity of dose-escalation of BCNU, etoposide and melphalan ('BEM') chemotherapy with autologous stem cell transplantation in patients with haematological malignancies. Seventy-two patients with haematological malignancies were treated with BCNU (600 mg/m2, 450 mg/m2 or 300 mg/m2), etoposide 2 g/m2 and melphalan 140 mg/m2 followed by autologous bone marrow transplantation (ABMT), n = 51, or autologous peripheral blood progenitor cell transplantation (APBPCT), n = 21. Liver and pulmonary function was monitored pretransplant and at regular intervals post-transplant. Mucositis was graded daily during in-patient stay. There was a significantly higher incidence of symptomatic pulmonary toxicity in the patients who received BCNU at 600 mg/m2 than in the other two groups, and there was a significant increase in the incidence of asymptomatic decrease in carbon monoxide (KCO) in the patients who received BCNU 450 mg/m2. There was no significant difference between the three groups in the incidence and severity of mucositis or in the incidence of transiently abnormal liver function. We conclude that etoposide at 2 g/m2 can be used without unacceptable mucositis. BCNU at 600 mg/m2 is associated with an unacceptably high incidence of lung toxicity, but at 450 mg/m2 there is minimal symptomatic lung toxicity.
authors.affiliation: Department of Haematology, Addenbrooke's Hospital NHS Trust, Cambridge, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ager
authors.forename: P
authors.initials: P
authors.lastname: Mahendra
authors.forename: E M
authors.initials: EM
authors.lastname: Richards
authors.forename: G
authors.initials: G
authors.lastname: Bass
authors.forename: T P
authors.initials: TP
authors.lastname: Baglin
authors.forename: R E
authors.initials: RE
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002330:Carmustine / Q000009:adverse effects; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008111:Liver Function Tests; D008223:Lymphoma / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000009:adverse effects; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D014182:Transplantation, Autologous
chemical_list: D005047:Etoposide; D008558:Melphalan; D002330:Carmustine