Effect of the dose per body weight of conditioning chemotherapy on severity of mucositis and risk of relapse after autologous haematopoietic stem cell transplantation in relapsed diffuse large B cell lymphoma.
High-dose chemotherapy and haematopoietic stem cell (HSC) transplantation is considered standard therapy in patients with chemosensitive relapsed diffuse large B cell lymphoma (DLBCL). BCNU (carmustine), etoposide, cytarabine and melphalan (BEAM) is a widely used standard DLBCL conditioning regimen. The practice of basing chemotherapy doses on body surface area (BSA) is empirical and the best biometric parameter to dose chemotherapy is unknown. Weight-based dosing has been suggested to better predict toxicity of the conditioning regimen. We correlated the dose/weight ratio with toxicity and overall outcome in a uniform cohort of 80 consecutive patients receiving HSC transplant for relapsed DLBCL at Mayo Clinic, Rochester, MN following BSA-dosed BEAM conditioning chemotherapy. Melphalan dose was used as surrogate for the entire regimen. Median age at the time of transplant was 62 (26-77) years; 65% were males. The median melphalan dose was 3.2 mg/kg (range 2.2-4.5). Patients who received >3.6 mg/kg of melphalan were more likely to have grade 3 or 4 mucositis (44.4% vs. 9.8%, P = 0.001) and prolonged hospitalization (median 13 vs. 7 d; P = 0.04). Dose/weight ratio did not correlate with cumulative incidence of relapse (P = 0.3) or survival (P = 0.8). Transplant physicians should consider limiting the dose of BEAM to the equivalent of 3.6 mg/kg of melphalan.
Costa
Luciano J
LJ
Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
Micallef
Ivana N
IN
Inwards
David J
DJ
Johnston
Patrick B
PB
Porrata
Luis F
LF
Litzow
Mark R
MR
Ansell
Stephen M
SM
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001835:Body Weight; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D052016:Mucositis / Q000139:chemically induced; D012008:Recurrence; D012306:Risk; D018709:Statistics, Nonparametric; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D003561:Cytarabine; D005047:Etoposide; D008558:Melphalan; D002330:Carmustine