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1.
Ann Hematol ; 80(4): 209-15, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11401086

RESUMO

To reduce the incidence of GvHD and the rate of graft failure in unrelated stem cell transplantation, we incorporate anti-thymocyte globulin in the preparative regimen in 98 patients with hematological or inherited storage disease. The median age was 32 years (range: 1-56) and 84 patients underwent transplantation from HLA-A,-B and DR identical donor, while in 14 patients the donor were mismatched either in HLA- A, -B or -DR locus. Only one patient with chronic myelocytic leukemia (CML) and blast crisis had a primary graft failure (1%). Grade II-IV acute GvHD occurred in 37 patients (37%), grade III/IV GvHD developed in 15 patients (15%). Chronic GvHD was observed in 29%, and only 12 patients had extensive GvHD (17%). After a median follow-up of 34 months (range, 9-90), the estimated overall survival at 3 years for all patients is 58% (CI 95%: 48%-68%), and the estimated disease-free survival at 3 years is 49% (CI 95%: 38%-60%). For patients with CML transplanted in first chronic phase or accelerated phase (n=40), the estimated overall survival at 3 years is 70% (CI 95%: 56%-84%), and the estimated disease-free survival at 3 years is 58% (CI 95%: 17%-85%). ATG in unrelated stem cell transplantation reduces the risk of severe acute and chronic GvHD and of graft failure without an obvious increase of severe infection. Further follow-up is mandatory to determine the incidence of late relapse.


Assuntos
Soro Antilinfocitário/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Doença Enxerto-Hospedeiro/prevenção & controle , Transplante de Células-Tronco Hematopoéticas , Condicionamento Pré-Transplante , Adolescente , Adulto , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Teste de Histocompatibilidade , Humanos , Lactente , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Recidiva , Reoperação , Transplante Homólogo , Resultado do Tratamento
2.
Bone Marrow Transplant ; 26(7): 711-6, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11042650

RESUMO

To evaluate the efficacy and toxicity of two different etoposide (VP-16) dosages (30 or 45 mg/kg) in combination with busulfan/cyclophosphamide as conditioning therapy followed by stem cell transplantation in acute myeloid leukemia (AML), 90 patients with AML received either 30 mg/kg (n = 60) or 45 mg/kg (n = 30) etoposide in combination with busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg). The stem cell source was allogeneic related bone marrow (BM) (n = 53), allogeneic unrelated BM (n = 5), allogeneic unrelated peripheral blood (PBSC) (n = 2), syngeneic BM (n = 2), autologous BM purged (n = 9) or unpurged (n = 9), autologous PBSC (n = 10). Fifty-six patients (62%) were in first CR, 26 (29%) were > first CR, and eight (9%) were transplanted in relapse. Principal toxicities in both groups were mucositis and hepatotoxicity. Forty-five mg/kg etoposide resulted in greater hepatic toxicity (P = 0.03), and a higher incidence of VOD (23 vs 12%, P = 0.04) and acute GVHD grade III/IV (13 vs 5%, NS). The treatment-related mortality was 17% in the 30 mg/kg group and 33% in the 45 mg/kg group, mainly due to infections, intestinal pneumonia and GVHD. Hematological recovery of leukocytes 1/nl was comparable in both groups (17 vs 16 days). After a median follow-up of 16 months 19% in the 30 mg/kg group and 23% in the 45 mg/kg group relapsed. In patients who had undergone allogeneic related bone marrow transplantation in first CR no relapses occurred after a median follow-up of 3 years. For all patients the 3-year estimated disease-free survival was 62% in the 30 mg/kg group and 40% in the 45 mg/kg group (P = 0.03). For patients in first CR who underwent allogeneic related stem cell transplantation the 3 year disease-free survivals were 80% and 66%, respectively (P = 0.4). We conclude that etoposide 30 mg/kg or 45 mg/kg in combination with busulfan/cyclophosphamide is a highly active regimen for bone marrow transplantation of patients with AML with a low relapse rate. However, conditioning with 30 mg/kg rather than 45 mg/kg etoposide resulted in less toxicity and a better overall survival due to a lower transplant-related mortality. Bone Marrow Transplantation (2000) 26, 711-716.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Etoposídeo/farmacologia , Transplante de Células-Tronco Hematopoéticas/métodos , Leucemia Mieloide/tratamento farmacológico , Condicionamento Pré-Transplante/métodos , Doença Aguda , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/toxicidade , Plaquetas/citologia , Bussulfano/administração & dosagem , Bussulfano/farmacologia , Bussulfano/toxicidade , Criança , Pré-Escolar , Ciclofosfamida/administração & dosagem , Ciclofosfamida/farmacologia , Ciclofosfamida/toxicidade , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Avaliação de Medicamentos , Etoposídeo/administração & dosagem , Etoposídeo/toxicidade , Feminino , Seguimentos , Sobrevivência de Enxerto , Doença Enxerto-Hospedeiro/etiologia , Humanos , Lactente , Leucemia Mieloide/complicações , Leucócitos/citologia , Masculino , Pessoa de Meia-Idade , Recidiva , Taxa de Sobrevida , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/normas , Resultado do Tratamento
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