title: Thiotepa/cyclophosphamide/TBI as a conditioning regimen for allogeneic hematopoietic stem cell transplantation in patients aged 50 years and over.
abstract: OBJECTIVE
  To reduce the relapse rate for hematological malignancies after allogeneic hematopoietic stem cell transplantation, we employed a myeloablative regimen comprising thiotepa 400 mg/m(2), cyclophosphamide 3,600 mg/m(2) and total body irradiation 10 Gy.
  
  
  METHODS
  Subjects comprised 17 patients (median age, 53 years; range, 50-56 years) with hematological malignancies who received allogeneic hematopoietic stem cell transplantation from HLA-identical related (n=6), HLA-mismatched family (n=2) or unrelated donors (n=9). Prophylaxis of acute graft-versus-host disease (GVHD) consisted of short-term methotrexate and cyclosporine (n=4) or short-term methotrexate and tacrolimus (n=13).
  
  
  RESULTS
  No grade IV regimen-related toxicities as determined by Bearman's criteria were encountered. Acute grade II-IV GVHD developed in 7 patients, with chronic GVHD in 11 patients. With a median follow-up of 39 months, 3 years survival rate after transplantation was 59%. Two patients died due to infection by 100 days after transplantation. Only 1 patient with Philadelphia-positive acute lymphoblastic leukemia experienced relapse. Eight patients died of non-leukemic causes (sepsis, n=2; liver dysfunction, n=2; idiopathic interstitial pneumonia, n=1; bacterial pneumonia, n=1; bronchiolitis obliterans resulting from chronic GVHD, n=1; and disseminated infection with varicella zoster virus, n=1).
  
  
  CONCLUSIONS
  This regimen was tolerable, but a large trial is warranted to confirm the efficacy of this conditioning.
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University School of Medicine, Yokohama. kfujimaki@livedoor.com
authors.forename: Katsumichi
authors.initials: K
authors.lastname: Fujimaki
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Tanaka
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Takasaki
authors.forename: Rie
authors.initials: R
authors.lastname: Hyo
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kawano
authors.forename: Rika
authors.initials: R
authors.lastname: Sakai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujita
authors.forename: Shin
authors.initials: S
authors.lastname: Fujisawa
authors.forename: Heiwa
authors.initials: H
authors.lastname: Kanamori
authors.forename: Atsuo
authors.initials: A
authors.lastname: Maruta
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage*; D054796:Drug Dosage Calculations; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013852:Thiotepa / Q000008:administration & dosage*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide; D013852:Thiotepa