Phase I study for poor-prognosis lymphoma: augmentation of the "BEAM" regimen with escalating dose melphalan using amifostine cytoprotection and autologous hematopoietic stem cell transplantation--a preliminary report.
We and others have previously shown that the use of amifostine (Ethyol; MedImmune Inc, Gaithersburg, MD) can ameliorate certain regimen-related toxicities of high-dose melphalan (HD-MEL) in the autologous hematopoietic stem cell transplant setting. Our recent experience indicated that the maximum tolerated dose of HD-MEL plus autologous hematopoietic stem cell transplant could be increased from approximately 200 mg/m2 to at least 280 mg/m2 with amifostine. Although a dose-limiting toxicity was not clearly identified, atrial fibrillation was noted in several patients. Phase II trials using this regimen have been reported in lymphoma and myeloma. Nonetheless, it is unlikely that single agent therapy, regardless of dose, will be highly curative in advanced hematologic malignancy. Thus, we used amifostine to permit dose escalation of HD-MEL within the BEAM (BCNU/etoposide/arabinosylcytosine/HD-MEL) combination chemotherapy regimen before autologous hematopoietic stem cell transplant in selected patients with lymphoma. Patient entry at the starting dose (ie, HD-MEL 140 mg/m2) has been completed without the development of severe regimen-related toxicities. This trial is ongoing.
Phillips
G L
GL
The James P. Wilmot Cancer Center, BMT Program, Rochester, NY 14642, USA.
Abboud
C N
CN
Bernstein
S H
SH
Friedberg
J W
JW
Ifthikharuddin
J J
JJ
Lancet
J E
JE
Liesveld
J L
JL
Spreng
E
E
Johnson
V
V
Chapman
M
M
Vesole
D H
DH
D000328:Adult; D004999:Amifostine / Q000627:therapeutic use* / Q000633:toxicity; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use* / Q000633:toxicity; D002330:Carmustine / Q000627:therapeutic use* / Q000633:toxicity; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000627:therapeutic use* / Q000633:toxicity; D019610:Cytoprotection; D005047:Etoposide / Q000627:therapeutic use* / Q000633:toxicity; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008223:Lymphoma / Q000628:therapy*; D008558:Melphalan / Q000627:therapeutic use* / Q000633:toxicity; D008875:Middle Aged; D011837:Radiation-Protective Agents / Q000009:adverse effects / Q000627:therapeutic use; D014182:Transplantation, Autologous
D011837:Radiation-Protective Agents; D003561:Cytarabine; D005047:Etoposide; D004999:Amifostine; D008558:Melphalan; D002330:Carmustine