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The toxicity of busulphan and cyclophosphamide as the preparative regimen for bone marrow transplantation
Author(s) -
Morgan M.,
Dodds A.,
Atkinson K.,
Szer J.,
Downs K.,
Biggs J.
Publication year - 1991
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1991.tb08621.x
Subject(s) - cyclophosphamide , medicine , bone marrow transplantation , regimen , busulfan , toxicity , transplantation , bone marrow , surgery , chemotherapy
S ummary . The toxicity of the conditioning regimen of high dose busulphan (Bu) (16 mg/kg) and cyclophosphamide (Cy) (120 mg/kg) has been compared to cyclophosphamide (Cy) (120 mg/kg) and fractionated total body irradiation (TBI) 12‐14 Gy. Since 1985, 67 patients have received conditioning of Bu and Cy for HLA‐identical sibling bone marrow transplants. 166 patients have received Cy and TBI since 1981. Veno‐occlusive disease of the liver occurred in 19% in the Bu‐Cy group and was fatal in 1/12 cases, but only in 1·3% of Cy‐TBI group ( P <0·0005) and was fatal in 1/2. 30% of evaluable patients developed haemorrhagic cystitis in the Bu‐Cy group and 14% in the Cy‐TBI group ( P =0·008). A multiple logistic regression analysis demonstrated the preparative regimen as the only significant risk factor for the development of veno‐occlusive disease or haemorrhagic cystitis. Interstitial pneumonia was diagnosed in 12/56 evaluable patients (21%) in the Bu‐Cy group and was fatal in 75%. It occurred in 39/1 37 evaluable patients (28%) in the Cy‐TBI group with a 54% case mortality. Within the Bu‐Cy group, the incidence of veno‐occlusive disease and haemorrhagic cystitis was similar in chronic myeloid leukaemia (CML) and acute leukaemia (AL) groups, but there was a significant ( P =0·003) incidence of interstitial pneumonia in the CML group 36% as compared to 7% in the AL group. Preparative regimen and age were significant risk factors in the development of interstitial pneumonia in patients with CML. A flexural and acral rash ranging from pigmentation to severe erosion was noted in the Bu‐Cy group, but not in the Cy‐TBI group. Thus, veno‐occlusive disease, haemorrhagic cystitis and cutaneous changes were more common in patients receiving Bu‐Cy. Interstitial pneumonia was more common in patients receiving Bu‐Cy for CML than for AL.