Perspectives on the Use of a Medium-Dose Etoposide, Cyclophosphamide, and Total Body Irradiation Conditioning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation: The Japanese Experience from 1993 to Present
The outcome for adults with acute lymphoblastic leukemia (ALL) treated with chemotherapy or autologous hematopoietic stem cell transplantation (HSCT) is poor. Therefore, allogeneic HSCT (allo HSCT) for adults aged less than 50 years with ALL is performed with myeloablative conditioning (MAC) regimen...
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doaj-45e7af262b7e402e8b81ab91d3d57d422020-11-25T00:40:29ZengMDPI AGJournal of Clinical Medicine2077-03832019-04-018556910.3390/jcm8050569jcm8050569Perspectives on the Use of a Medium-Dose Etoposide, Cyclophosphamide, and Total Body Irradiation Conditioning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation: The Japanese Experience from 1993 to PresentMasahiro Imamura0Akio Shigematsu1Former Professor of Department of Hematology, Hokkaido University Faculty of Medicine, Graduate School of Medicine, Kita-15 Jyo, Nishi-7 Chome, Kita-ku, Sapporo 060-8638, JapanDepartment of Hematology, Sapporo Hokuyu Hospital, 6-6-5-1 Higashi-sapporo, Shiroishi-ku, Sapporo 003-0006, JapanThe outcome for adults with acute lymphoblastic leukemia (ALL) treated with chemotherapy or autologous hematopoietic stem cell transplantation (HSCT) is poor. Therefore, allogeneic HSCT (allo HSCT) for adults aged less than 50 years with ALL is performed with myeloablative conditioning (MAC) regimens. Among the several MAC regimens, a conditioning regimen of 120 mg/kg (60mg/kg for two days) cyclophosphamide (CY) and 12 gray fractionated (12 gray in six fractions for three days) total body irradiation (TBI) is commonly used, resulting in a long term survival rate of approximately 50% when transplanted at the first complete remission. The addition of 30 mg/kg (15 mg/kg for two days) etoposide (ETP) to the CY/TBI regimen revealed an excellent outcome (a long-term survival rate of approximately 80%) in adults with ALL, showing lower relapse and non-relapse mortality rates. It is preferable to perform allo HSCT with a medium-dose ETP/CY/TBI conditioning regimen at the first complete remission in high-risk ALL patients and at the second complete remission (in addition to the first complete remission) in standard-risk ALL patients. The ETP dose and administration schedule are important factors for reducing the relapse and non-relapse mortality rates, preserving a better outcome. The pharmacological study suggests that the prolonged administration of ETP at a reduced dose is a promising treatment.https://www.mdpi.com/2077-0383/8/5/569allogeneic hematopoietic stem cell transplantationacute lymphoblastic leukemiaconditioning regimenmedium-dose etoposidecyclophosphamidetotal body irradiationpharmacokineticspharmacodynamics |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Masahiro Imamura Akio Shigematsu |
spellingShingle |
Masahiro Imamura Akio Shigematsu Perspectives on the Use of a Medium-Dose Etoposide, Cyclophosphamide, and Total Body Irradiation Conditioning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation: The Japanese Experience from 1993 to Present Journal of Clinical Medicine allogeneic hematopoietic stem cell transplantation acute lymphoblastic leukemia conditioning regimen medium-dose etoposide cyclophosphamide total body irradiation pharmacokinetics pharmacodynamics |
author_facet |
Masahiro Imamura Akio Shigematsu |
author_sort |
Masahiro Imamura |
title |
Perspectives on the Use of a Medium-Dose Etoposide, Cyclophosphamide, and Total Body Irradiation Conditioning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation: The Japanese Experience from 1993 to Present |
title_short |
Perspectives on the Use of a Medium-Dose Etoposide, Cyclophosphamide, and Total Body Irradiation Conditioning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation: The Japanese Experience from 1993 to Present |
title_full |
Perspectives on the Use of a Medium-Dose Etoposide, Cyclophosphamide, and Total Body Irradiation Conditioning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation: The Japanese Experience from 1993 to Present |
title_fullStr |
Perspectives on the Use of a Medium-Dose Etoposide, Cyclophosphamide, and Total Body Irradiation Conditioning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation: The Japanese Experience from 1993 to Present |
title_full_unstemmed |
Perspectives on the Use of a Medium-Dose Etoposide, Cyclophosphamide, and Total Body Irradiation Conditioning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation: The Japanese Experience from 1993 to Present |
title_sort |
perspectives on the use of a medium-dose etoposide, cyclophosphamide, and total body irradiation conditioning regimen in allogeneic hematopoietic stem cell transplantation: the japanese experience from 1993 to present |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2019-04-01 |
description |
The outcome for adults with acute lymphoblastic leukemia (ALL) treated with chemotherapy or autologous hematopoietic stem cell transplantation (HSCT) is poor. Therefore, allogeneic HSCT (allo HSCT) for adults aged less than 50 years with ALL is performed with myeloablative conditioning (MAC) regimens. Among the several MAC regimens, a conditioning regimen of 120 mg/kg (60mg/kg for two days) cyclophosphamide (CY) and 12 gray fractionated (12 gray in six fractions for three days) total body irradiation (TBI) is commonly used, resulting in a long term survival rate of approximately 50% when transplanted at the first complete remission. The addition of 30 mg/kg (15 mg/kg for two days) etoposide (ETP) to the CY/TBI regimen revealed an excellent outcome (a long-term survival rate of approximately 80%) in adults with ALL, showing lower relapse and non-relapse mortality rates. It is preferable to perform allo HSCT with a medium-dose ETP/CY/TBI conditioning regimen at the first complete remission in high-risk ALL patients and at the second complete remission (in addition to the first complete remission) in standard-risk ALL patients. The ETP dose and administration schedule are important factors for reducing the relapse and non-relapse mortality rates, preserving a better outcome. The pharmacological study suggests that the prolonged administration of ETP at a reduced dose is a promising treatment. |
topic |
allogeneic hematopoietic stem cell transplantation acute lymphoblastic leukemia conditioning regimen medium-dose etoposide cyclophosphamide total body irradiation pharmacokinetics pharmacodynamics |
url |
https://www.mdpi.com/2077-0383/8/5/569 |
work_keys_str_mv |
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