Toxicity

There are important differences in toxicities among the various studies, in part related to the intensities of the regimens used, the ages of the patients studied, and the nature of the grafts used (sibling vs unrelated and HLA-matched vs mismatched). The 100-day TRM ranged from <5% in HLA-matched nonmyeloablative HCT recipients conditioned with low-dose TBI + / — fludarabine18 to 37% in patients given melphalan and purine-analog-containing preparative regimens.34 In a multicenter European Bone Marrow Transplant (EBMT) study reporting on 188 transplants for lymphoma with various reduced-intensity or nonmye-loablative conditioning regimens, the 100-day and 1-year probabilities of TRM were 13 and 26%, respectively, and those were significantly higher in older patients.46

Analysis of data from the first 45 patients receiving 2 Gy TBI as a conditioning regimen showed that no patients experienced regimen-related painful mucosi-tis, pulmonary toxicity, cardiac toxicity, veno-occlusive disease of the liver, hemorrhagic cystitis, or new onset alopecia.9 Fifty-three percent of eligible patients were treated entirely in the outpatient department, with others having relatively short hospitalizations (median 8 days). The hematologic changes were much milder than those observed after conventional HCT (Figure 96.3). Platelet and red blood cell transfusion requirements were significantly reduced in these patients compared to a concurrent group of myeloablative recipients, with 77% of patients not requiring platelet and 37% not requiring red blood cell transfusions.47 Liver and lung toxicities were also significantly reduced after nonmyeloablative HCT. The frequency of a bilirubin >4 mg/dL was 26% at 200 days in 193 consecutive nonmyeloablative HCT recipients versus 48% at 100 days in 1419 consecutive allogeneic HCT recipients conditioned with cyclophosphamide-based myeloablative regimens.48 The 120-day cumulative incidence of idiopathic pneumonia syndrome was 2.2% in 183 nonmyeloablative HCT recipients versus 8.4% in 917 recipients of myeloablative conditioning regimens.49

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