Long-term follow-up of busulfan, etoposide, and nimustine hydrochloride (ACNU) or melphalan as conditioning regimens for childhood acute leukemia and lymphoma.
We retrospectively evaluated early and long-term complications of an intensified conditioning regimen consisting of busulfan and etoposide in combination with either nimustine hydrochloride (ACNU) (BVA regimen, n = 18) or melphalan (BVL regimen, n = 34) in 52 children with acute leukemia or non-Hodgkin's lymphoma. With a median follow-up of 13.2 years after the BVA regimen and 8.1 years after the BVL regimen, 61% and 76% of patients, respectively, are in continuous complete remission. Transplantation-related mortality was 17% and 6% after the BVA and BVL regimens, respectively, and the corresponding relapse rates were 17% and 15%. The most common and severe toxicity was pulmonary complication in the BVA regimen, which was seen in 67% of patients and was life-threatening in 20%. Thirty-three percent of patients after the BVA regimen and 24% after BVL died of relapse or disease progression (n = 9), interstitial pneumonia (n = 2), fungal pneumonia (n = 1), or chronic graft-versus-host disease (n = 2). One of the long-term survivors developed secondary leukemia. A significant decrease in the height standard deviation score of more than 2 SD from diagnosis to the last follow-up was seen in 17% of the patients, with hypothyroidism in 15%, and alopecia in 42%. Because our experience is limited to a small heterogeneous population of patients who mainly underwent transplantation in the first remission, we cannot draw conclusions on the treatment's effectiveness. The BVL regimen is tolerable, however, because no regimen-related death was observed, whereas the BVA regimen is not recommended because of the high incidence of pulmonary complications. The effectiveness of the BVL regimen requires further study.
Izaki
Sakurako
S
Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Japan. sakura-306@cronos.ocn.ne.jp
Goto
Hiroaki
H
Okuda
Kumiko
K
Matsuda
Motoi
M
Watanabe
Yuka
Y
Fujioka
Kenichirou
K
Hanzawa
Noriyuki
N
Sumita
Hiroko
H
Takahashi
Hiroyuki
H
Goto
Shoko
S
Kai
Sumio
S
Sekiguchi
Haruyuki
H
Funabiki
Tetsunori
T
Sasaki
Hideki
H
Ikuta
Koichiro
K
Yokota
Shumpei
S
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002066:Busulfan / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000401:mortality* / Q000628:therapy; D008223:Lymphoma; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000628:therapy; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D015376:Nimustine / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
D015376:Nimustine; D005047:Etoposide; D002066:Busulfan; D008558:Melphalan