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4-hydroperoxycyclophosphamide--purged peripheral blood stem cells for autologous transplantation in patients with acute myeloid leukemia.

Publication ,  Journal Article
Rizzieri, DA; Talbot, JT; Long, GD; Vredenburgh, JJ; Gasparetto, C; Smith, CS; Colvin, MO; Adams, D; Morris, A; Dodge, R; Loftis, J; Reese, M ...
Published in: Biol Blood Marrow Transplant
March 2003

We have performed a phase I dose escalation of 4-Hydroperoxycyclophosphamide (4HC) purging of autologous peripheral blood progenitor cells (PBPCs) to improve the outcome of autologous transplantation for patients with myeloid leukemia. Peripheral blood stem cells were mobilized after cytosine arabinoside of 2 g/m(2) every 12 hours x 8 doses with etoposide of 40 mg/kg total dose infused over 4 days, followed by growth factor support. The preparative regimen included Busulfan of 1 mg/kg orally every 6 hours x 16 doses, followed by etoposide of 60 mg/kg x 1 day (the patient with chronic myeloid leukemia received cyclophosphamide of 60 mg/kg/d x 2 days in lieu of etoposide). PBPCs purged with 4HC were infused following this induction. Toxicities included grade 3 or 4 skin rashes, stomatitis/mucositis, and delay in time to hematopoietic recovery. The maximum tolerated dose of 4HC used to purge PBPCs in this trial was 20 microg/mL, which resulted in an average of 18 days for white blood cells and 28 days for platelet recovery. With a median follow-up of 2.25 years in surviving patients, the 3-year disease free survival rate is 44% and the overall survival rate is 89%. These data suggest that autologous PBPCs are more sensitive than marrow purged with 4HC, tolerating less intense purging, although a survival advantage may still be seen and should be assessed in larger studies. Approaches to minimize stomatitis and protect normal stem cells from the toxicity of 4HC may improve the tolerance and efficacy of this approach.

Duke Scholars

Published In

Biol Blood Marrow Transplant

DOI

ISSN

1083-8791

Publication Date

March 2003

Volume

9

Issue

3

Start / End Page

183 / 188

Location

United States

Related Subject Headings

  • Transplantation, Autologous
  • Survival Analysis
  • Remission Induction
  • Peripheral Blood Stem Cell Transplantation
  • Neoplastic Cells, Circulating
  • Middle Aged
  • Maximum Tolerated Dose
  • Male
  • Leukocytes, Mononuclear
  • Leukemia, Myeloid
 

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Rizzieri, D. A., Talbot, J. T., Long, G. D., Vredenburgh, J. J., Gasparetto, C., Smith, C. S., … Chao, N. J. (2003). 4-hydroperoxycyclophosphamide--purged peripheral blood stem cells for autologous transplantation in patients with acute myeloid leukemia. Biol Blood Marrow Transplant, 9(3), 183–188. https://doi.org/10.1053/bbmt.2003.50011
Rizzieri, David A., Jeffrey T. Talbot, Gwynn D. Long, James J. Vredenburgh, Christina Gasparetto, Clayton S. Smith, Michael O. Colvin, et al. “4-hydroperoxycyclophosphamide--purged peripheral blood stem cells for autologous transplantation in patients with acute myeloid leukemia.Biol Blood Marrow Transplant 9, no. 3 (March 2003): 183–88. https://doi.org/10.1053/bbmt.2003.50011.
Rizzieri DA, Talbot JT, Long GD, Vredenburgh JJ, Gasparetto C, Smith CS, et al. 4-hydroperoxycyclophosphamide--purged peripheral blood stem cells for autologous transplantation in patients with acute myeloid leukemia. Biol Blood Marrow Transplant. 2003 Mar;9(3):183–8.
Rizzieri, David A., et al. “4-hydroperoxycyclophosphamide--purged peripheral blood stem cells for autologous transplantation in patients with acute myeloid leukemia.Biol Blood Marrow Transplant, vol. 9, no. 3, Mar. 2003, pp. 183–88. Pubmed, doi:10.1053/bbmt.2003.50011.
Rizzieri DA, Talbot JT, Long GD, Vredenburgh JJ, Gasparetto C, Smith CS, Colvin MO, Adams D, Morris A, Dodge R, Loftis J, Waters-Pick B, Reese M, Carawan H, Koh LP, Chao NJ. 4-hydroperoxycyclophosphamide--purged peripheral blood stem cells for autologous transplantation in patients with acute myeloid leukemia. Biol Blood Marrow Transplant. 2003 Mar;9(3):183–188.
Journal cover image

Published In

Biol Blood Marrow Transplant

DOI

ISSN

1083-8791

Publication Date

March 2003

Volume

9

Issue

3

Start / End Page

183 / 188

Location

United States

Related Subject Headings

  • Transplantation, Autologous
  • Survival Analysis
  • Remission Induction
  • Peripheral Blood Stem Cell Transplantation
  • Neoplastic Cells, Circulating
  • Middle Aged
  • Maximum Tolerated Dose
  • Male
  • Leukocytes, Mononuclear
  • Leukemia, Myeloid