Toxicities after peripheral blood progenitor cell transplantation for lymphoid malignancies: analysis of 300 cases in a single institution.
Two hundred and seventy-seven consecutive patients with non-Hodgkin's lymphoma (n = 207), Hodgkin's disease (n = 27) and multiple myeloma (n = 43) were intensified from October 1989 until April 1997 and received unmanipulated PBPC transplants. Twenty-three patients received a double intensification, out of a total of 300 PBPC transplantations analyzed. Conditioning regimens consisted of total body irradiation (TBI)-containing regimens (n = 141), BEAM (n = 104), high-dose melphalan (n = 26), ICE (n = 23) or other regimens (n = 6). Eighty-four percent of the patients (119/142) evaluable for long-term hematological reconstitution beyond 180 days achieved normal trilineage blood counts. Abnormal hematological parameters were associated with low numbers of CD34+ cells re-infused and with prior exposure to fludarabine. The 100-day and long-term treatment-related mortality rates were 4% and 4%, respectively. Late complications and treatment-related toxicities were influenced by disease history, use of TBI and exposure to fludarabine. Patients older than 60 years did not have greater toxicities or more frequent treatment-related deaths. This analysis suggests that while leading to a limited morbidity and a low mortality rate, intensive chemotherapy with PBPC transplantation still remains a procedure leading to significant short- and long-term toxicities. Better recognition of the risk factors associated with these complications might allow a further decrease in their incidence.
Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, France.
N
N
Ketterer
A
A
Sonet
C
C
Dumontet
I
I
Moullet
C
C
Thieblemont
D
D
Espinouse
F
F
Bouafia
B
B
Coiffier
G
G
Salles
D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34; D005260:Female; D006410:Hematopoiesis; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation
D018952:Antigens, CD34; D007166:Immunosuppressive Agents; D014740:Vidarabine; C024352:fludarabine