Ozkaynak M Fevzi, Sahdev Indira, Gross Thomas G, Levine John E, Cheerva Alexandra C, Richards Michael K, Rozans Marta K, Shaw Peter J, Kadota Richard P
Department of Pediatrics, Section of Hematology/Oncology, New York Medical College, Valhalla, NY 10595, USA.
J Pediatr Hematol Oncol. 2008 Mar;30(3):204-9. doi: 10.1097/MPH.0b013e318162bd0c.
Limited information is available regarding the use of amifostine in pediatric hematopoietic stem cell transplant (HSCT) patients. Melphalan, carboplatin, etoposide +/- cyclophosphamide is a commonly used preparatory regimen in pediatric solid tumor HSCT. Therefore, we decided to determine the feasibility of the addition of amifostine (750 mg/m b.i.d. x 4 d) to melphalan (200 mg/m), carboplatin (1200 mg/m), and etoposide (800 mg/m) (level 1) and escalating doses of cyclophosphamide (3000 mg/m and 3800 mg/m, levels 2 and 3, respectively) followed by autologous HSCT. Thirty-two patients with a variety of pediatric solid tumors were studied. Seventeen patients were accrued at level 1, 9 at level 2, and 6 at level 3. Major toxicities during the administration of the preparatory regimen were hypocalcemia, emesis, and hypotension. Hypocalcemia required aggressive calcium supplementation during the conditioning phase. No dose limiting toxicities were encountered at level 3. Amifostine at 750 mg/m b.i.d. for 4 days can be administered with a double alkylator regimen consisting of melphalan (200 mg/m), cyclophosphamide (up to 3800 mg/m), carboplatin (1200 mg/m), and etoposide (800 mg/m) with manageable toxicities.
关于氨磷汀在儿科造血干细胞移植（HSCT）患者中的应用，可用信息有限。美法仑、卡铂、依托泊苷±环磷酰胺是儿科实体瘤HSCT中常用的预处理方案。因此，我们决定确定在美法仑（200mg/m²）、卡铂（1200mg/m²）和依托泊苷（800mg/m²）（1级）中加入氨磷汀（750mg/m²，每日两次，共4天）以及递增剂量的环磷酰胺（分别为3000mg/m²和3800mg/m²，2级和3级）后进行自体HSCT的可行性。对32例患有各种儿科实体瘤的患者进行了研究。1级纳入17例患者，2级纳入9例，3级纳入6例。预处理方案给药期间的主要毒性为低钙血症、呕吐和低血压。低钙血症在预处理阶段需要积极补充钙剂。3级未出现剂量限制性毒性。氨磷汀750mg/m²，每日两次，共4天，可与由美法仑（200mg/m²）、环磷酰胺（剂量高达3800mg/m²）、卡铂（1200mg/m²）和依托泊苷（800mg/m²）组成的双烷化剂方案联合使用，毒性可控。
