Regimen-related toxicity in patients undergoing bone marrow transplantation.

Abstract

Bone marrow transplantation is associated with significant morbidity and mortality, some of which is due to high-dose chemoradiotherapy. In order to quantitate toxicity that was felt to be due to the preparative regimen (termed regimen-related toxicity [RRT]), a system was developed in which toxicities were graded from 0 (none) to 4 (fatal). One hundred ninety-five patients who underwent marrow transplantation for leukemia were studied retrospectively to determine whether toxicities that were clinically felt to be due to the preparative regimen were influenced by other factors such as disease status, graft-versus-host disease (GVHD) prophylaxis, and allogenicity. All patients developed grade I toxicity in at least one organ, and 30 developed grades III-IV (life-threatening or fatal) RRT. RRT was more common in relapsed patients v remission patients (P = .04), in those receiving 15.75 Gy total body irradiation (TBI) v 12.0 Gy TBI (P = .028), and in those receiving allogeneic marrow v autologous marrow (P = .0029). Autologous marrow recipients did not develop grades III-IV toxicity in this study. A multivariate analysis controlling for autologous marrow grafting showed that the dose of TBI was the only statistically significant predictor of grades III-IV RRT. Those patients who developed grade III RRT were unlikely to survive 100 days from transplant, though not all deaths could be attributed to RRT. Patients who developed grade II toxicity in three or more organs were more likely to die within 100 days than those developing grade II toxicity in two or less organs (P = .0027). This system was generally able to distinguish RRT from other toxicities observed in marrow recipients.

Prospective phase II trial to evaluate the complications and kinetics of chimerism induction following allogeneic hematopoietic stem cell transplantation with fludarabine and busulfan

“…Regimen-related toxicity (RRT) was graded using the Seattle criteria [18] on the day before the initiation of conditioning regimens and at least 3 days a week until Day 20 after transplantation. All other observed adverse events were graded according to the National Cancer Institute Common Toxicity Criteria version 2.0 (NCI-CTC ver.…”

Successful allogeneic bone marrow transplantation in selected patients over 50 years of age – a single institution’s experience

“…A number of уgrade 1 regimen-related toxicities (Bearman toxicity scale 20 ) including cardiac, gastrointestinal, oral, hepatic and renal toxicities were more frequently observed in older patients (see Table 3). The incidence rate of any severe events (уgrade 3) were 20% vs 10% vs 3% for the Ͼ50 years, 40-50 years, and Ͻ40 years group.…”

Peripheral blood stem cell autografts for the treatment of children over 1 year old with stage IV neuroblastoma: a long-term follow-up

“…One patient who was transplanted with refractory disease died of disease progression without any benefit from transplantation. In the remaining patients, the RRT score by Bearman's grading system 16 remained below 2 in each subject. Hematological recovery was evaluated in 21 patients, excluding one very early death.…”

“…Hematological recovery was evaluated in 21 patients, excluding one very early death. The median number of days to achieve an absolute granulocyte count of Ͼ0.5 ϫ 10 9 /l and a WBC count of Ͼ1.0 ϫ 10 9 /l was, respectively, 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The median time required for platelets to rise above 50 ϫ 10 9 /l was 46 days (11-168 days).…”