Conditioning regimens including high-dose busulfan cause a high incidence of transplant-related mortality after myeloablative stem cell transplantation.
BACKGROUND
Transplant-related mortality (TRM) significantly decreases the long-term survival of patients with hematopoietic diseases who undergo hematopoietic stem cell transplantation (HSCT).


METHODS
We retrospectively evaluated the risk factors for TRM of 58 consecutive patients with hematopoietic disease who underwent allogeneic myeloablative HSCT between April 1994 and June 2002.


RESULTS
Thirty-one patients died after HSCT, 16 of whom were diagnosed as TRM. The actuarial incidence of TRM was 57.6 % in patients who received conditioning chemotherapies including high-dose busulfan and 19.4 % in those who did not (p = 0.008). Multivariate Cox model analysis revealed that disease status, graft versus host disease (GVHD) grades III-IV and the use of high-dose busulfan were significant and independent risk factors for TRM.


CONCLUSIONS
These results suggest that high-dose busulfan as a conditioning therapy for allogeneic HSCT should be used cautiously, especially in patients with advanced disease.
Nakamae
Hirohisa
H
Clinical Hematology and Clinical Diagnostics, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. hirohisa@msic.med.osaka-cu.ac.jp
Yamane
Takahisa
T
Aoyama
Yasutaka
Y
Yamamura
Ryousuke
R
Ohta
Kensuke
K
Hino
Masayuki
M
D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects* / Q000627:therapeutic use*; D002066:Busulfan / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006086:Graft vs Host Disease; D006304:Health Status; D019337:Hematologic Neoplasms / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000401:mortality*; D014184:Transplantation, Homologous
D018906:Antineoplastic Agents, Alkylating; D002066:Busulfan