Thiotepa/cyclophosphamide/TBI as a conditioning regimen for allogeneic hematopoietic stem cell transplantation in patients aged 50 years and over.
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.
Fujimaki
Katsumichi
K
Department of Internal Medicine and Clinical Immunology, Yokohama City University School of Medicine, Yokohama. kfujimaki@livedoor.com
Tanaka
Masatsugu
M
Takasaki
Hirotaka
H
Hyo
Rie
R
Kawano
Tomoko
T
Sakai
Rika
R
Fujita
Hiroyuki
H
Fujisawa
Shin
S
Kanamori
Heiwa
H
Maruta
Atsuo
A
Ishigatsubo
Yoshiaki
Y
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
D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide; D013852:Thiotepa