LEUKEMIA: STEM CELL TRANSPLANT

 

Regimen/Number

Of Patients

Drug Dose and Route

Leukopenia/

Neutropenia

Toxicity

Anemia

Toxicity

Other

Grade III-IV Toxicities

Emetogenic

Potential

Consequences of

Adverse Event(s)

BEAC

(Rapoport AP, et al.

J Clin Oncol.

1993;11:2351-2361)

 

 

N = 90
Day – 7

Carmustine 300 mg/m2 IV

 

Day –6 through Day –3

Etoposide 100 mg/m2 q12h IV

Cytarabine 100 mg/m2 q12h IV

 

Day 0

Autologous stem calls reinfused

Filgrastim or sargramostim 5 mcg/kg/d

IV or SQ (40 patients)

Grade IV 100%

 

Neutropenic Fever 100%

Fungal Sepsis 3%

Intersititial

Pneumonitis 8%

Hepatic

(bili ≥ 10 mg/dl) 8%

Cardiomyopathy 4%

Graft Failure 3%

Cystitis 1%

Days –7

through –3

―level 5

patients died from

interstitial pneumonitis

5 patients died from

hepatoxicity

4 patients died from

cardiomyopathy

All 3 patients with

fangal sepsis died

2 patients with graft failure died

1 patients had chronic bladder cycfunction

BEAM

(Mills W, et al.

J Clin, Oncol.

1995;13:588-595)

 

N = 107
Day 1

Carmustine 300 mg/m2 IV

 

Day 2 through Day 5

Etoposide 200 mg/m2/d IV

Cytarabine 200 mg/m2 q12h IV

 

Day 6

Melphalan 140 mg/m2 IV

 

Day 0 (day after Melphalan)

Autologous stem cells reinfused

See ASCO guidelines for growth-factor

recommendations

Neutropenia

100%

 

Febrile Neutropenia* 98%

Mucositis* 100%

Abdominal pain* 65%

Diarrhea* 82%

Hemodynamically

Significant

Hematemesis,

Hematochezia,

or Melana* 7%

Pulmonary* 17%

 

*Grade unknown

Days 1 –6 ―

level 5

3 patients died from

overwhelming sepsis

2 patients died from

pneumonitis sepsis

2 patients died from

intracerebral bleeding

1 patients died from

venooclusive disease

of the liver

Gram negative infection

in 42%

Gram positive Infection

in 47%

 

CBV

(Weaver CH, et al.

J Clin Oncol.

1993;11:1329-1335

 

N = 57
Day –8 through Day –6

Etoposide 400 mg/m2 q12h IV*

Carmustine 100-200 mg/m2/d IV

 

Day –5 through Day –2

Cyclophosphamide 1800 mg/m2/d IV

 

Day 0

Autologous stem cells reinfused

 

*Patients < 40 years received 200 mg/m2/d;

patients ≥ 40 years received 100 mg/m2/d

See ASCO guidelines for growth-factor

recommendations

Not reported ―

assumed 100%

of patients had

neutropenia

 

Pulmonary 23%

Hepatic 9%

Renal 7%

Cardiac 5%

Bladder 2%

All days―

level 5

patients died before

day 100 from toxicities

due to the treatment

regimen (venoocclusive

disease, multiorgan

failure, nephrotoxicity,

cardiac toxicity)

5 patients died from

infection