Regimenrelated Toxicity

Toxicities that can be directly attributed to the prepar ative regimen are referred to as regimen-related toxici ties (RRTs). Excluded are infection, hemorrhage, and graft-versus-host disease (GVHD). Less clear are the toxicities that are the result of GVHD prophylaxis. Although flawed, a set of criteria developed in Seattle in the late 1980s remains one of the few designed to evaluate toxicity from myeloablative therapy.1 This system was devised in patients who were prepared for transplantation using cyclophosphamide and total body irradiation (TBI). Life-threatening or fatal RRT was more common in patients who received higher TBI doses, who were transplanted with relapsed disease, and who received allogeneic versus autologous grafts. It also demonstrated that RRT was cumulative.

Patients who developed grade 2 RRT in three or more organs were more likely to die by day 100 than those who developed grade 2 RRT in fewer organs.

Preparative regimens, particularly those that are myeloablative, usually employ noncross resistant drugs with nonoverlapping, nonhematopoietic toxici-ties. Dose-limiting toxicities are to nonhematopoietic organs and are similar among the different regimens (Table 100.1). The spectrum of such toxicities may change as newer immunosuppressive regimens that do not include methotrexate are studied.2-5

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