ABSTRACT
Limited information is available regarding the use of amifostine in pediatric hematopoietic stem cell transplant (HSCT) patients. Melphalan, carboplatin, etoposide +/- cyclophosphamide is a commonly used preparatory regimen in pediatric solid tumor HSCT. Therefore, we decided to determine the feasibility of the addition of amifostine (750 mg/m b.i.d. x 4 d) to melphalan (200 mg/m), carboplatin (1200 mg/m), and etoposide (800 mg/m) (level 1) and escalating doses of cyclophosphamide (3000 mg/m and 3800 mg/m, levels 2 and 3, respectively) followed by autologous HSCT. Thirty-two patients with a variety of pediatric solid tumors were studied. Seventeen patients were accrued at level 1, 9 at level 2, and 6 at level 3. Major toxicities during the administration of the preparatory regimen were hypocalcemia, emesis, and hypotension. Hypocalcemia required aggressive calcium supplementation during the conditioning phase. No dose limiting toxicities were encountered at level 3. Amifostine at 750 mg/m b.i.d. for 4 days can be administered with a double alkylator regimen consisting of melphalan (200 mg/m), cyclophosphamide (up to 3800 mg/m), carboplatin (1200 mg/m), and etoposide (800 mg/m) with manageable toxicities.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hematopoietic Stem Cell Transplantation , Neoplasms/therapy , Adolescent , Adult , Amifostine/administration & dosage , Amifostine/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Bone Marrow Transplantation , Bone Neoplasms/diagnosis , Bone Neoplasms/therapy , Carboplatin/administration & dosage , Central Nervous System Neoplasms/diagnosis , Central Nervous System Neoplasms/therapy , Child , Child, Preschool , Combined Modality Therapy , Cyclophosphamide/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug-Related Side Effects and Adverse Reactions , Etoposide/administration & dosage , Feasibility Studies , Hodgkin Disease/diagnosis , Hodgkin Disease/therapy , Humans , Hypocalcemia/chemically induced , Hypocalcemia/pathology , Kidney Neoplasms/diagnosis , Kidney Neoplasms/therapy , Melphalan/administration & dosage , Neoplasms/diagnosis , Neuroblastoma/diagnosis , Neuroblastoma/therapy , Pilot Projects , Recurrence , Risk Factors , Sarcoma/diagnosis , Sarcoma/therapy , Transplantation, Autologous , Transplantation, Homologous , Treatment Outcome , Wilms Tumor/diagnosis , Wilms Tumor/therapyABSTRACT
Bacillus species are increasingly recognized as pathogens in immunocompromised patients. The authors report a case of Bacillus cereus infection of a central line in an immunocompetent patient with hemophilia, which required line removal for complete cure.
