title: Efficacy of etoposide, cyclophosphamide, and total body irradiation in allogeneic bone marrow transplantation for adult patients with hematological malignancies.
abstract: BACKGROUND
  A combination of fractionated total body irradiation (TBI) with etoposide (VP-16) and cyclophosphamide (CY) as a preconditioning regimen (VP/CY/TBI) has been reported to be safe and effective for both adults and children undergoing allogeneic bone marrow transplantation (allo-BMT). However, the reported doses of VP-16 were different. We evaluated the efficacy and safety of a VP-16 (at less than the usual dose)/CY/TBI regimen for adults with hematological malignancies who are required to receive allo-BMT.
  
  
  METHODS
  Thirty-eight patients received VP-16, CY and TBI (VP/CY/TBI) as a preconditioning regimen for allo-BMT. Twenty-one patients were in first complete remission (1CR), six patients were in second remission (2CR) and 11 patients were in non-remission status (non-CR) before allo-BMT. These patients received allo-BMT from related donors (n=14) and unrelated donors (n=24). The preconditioning regimen consisted of VP-16 (15 mg/kg/d for 2 d), CY (60 mg/kg/d for 2 d) and 12 Gy TBI in six fractions for 3 d.
  
  
  RESULTS
  Two patients died on day 30 after transplantation. The median follow-up period for all patients was 35.0 months (range 0.8-159.6 months). At the time of analysis, 10 patients had died. Seven of those 10 patients died because of relapse. The estimated 5-yr disease-free survival (DFS) rates for all cases and acute myelogenous leukemia and acute lymphoblastic leukemia cases were 73.6, 66.7 and 100%, respectively. The estimated 5-yr DFS rates for 1CR, 2CR and non-CR cases were 90.5, 83.3 and 40.9%, respectively (p < 0.05).
  
  
  CONCLUSIONS
  Based on these findings, we suggest that a VP/CY/TBI regimen is effective and safe for adult patients with hematological malignancies in 1CR and 2CR.
authors.affiliation: Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. ttoubai@hkg.odn.ne.jp
authors.forename: Tomomi
authors.initials: T
authors.lastname: Toubai
authors.forename: Junji
authors.initials: J
authors.lastname: Tanaka
authors.forename: Akio
authors.initials: A
authors.lastname: Mori
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hashino
authors.forename: Sumiko
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ota
authors.forename: Yoko
authors.initials: Y
authors.lastname: Miura
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kahata
authors.forename: Ko
authors.initials: K
authors.lastname: Izumiyama
authors.forename: Masakatu
authors.initials: M
authors.lastname: Yonezumi
authors.forename: Koji
authors.initials: K
authors.lastname: Chiba
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondo
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Toyoshima
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000293:Adolescent; D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002423:Cause of Death; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D012449:Safety; D015996:Survival Rate; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D005047:Etoposide; D003520:Cyclophosphamide