Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic,9500 Euclid Avenue, Cleveland, OH 44195, USA.
Bone Marrow Transplant. 2012 May;47(5):633-8. doi: 10.1038/bmt.2011.167. Epub 2011 Aug 29.
BU and CY is a common conditioning regimen for allogeneic hematopoietic progenitor cell transplantation (HPCT). I.v. BU is increasingly used in place of the oral formulation for conditioning. We compared the outcomes of 135 consecutively treated AML and myelodysplastic syndrome patients who underwent allogeneic HPCT at our institution with BUCY2 using oral (n=93) or i.v. (n=42) BU, without dose adjustment. The i.v. BU patients had a lower incidence of any severity of oral mucositis (3 versus 55%, P=0.002) and severe mucositis (3 versus 24%, P=0.005). Other post transplant outcomes were comparable between the groups. In all 26 i.v. BU and 33 oral BU patients are alive; however, the median follow-up was significantly longer for the oral BU group. One- and two-year non-relapse mortality for the i.v. BU patients was 21% for both, and for the oral BU group was 23% and 29%, respectively. One- and two-year relapse mortality for the i.v. BU patients was 21% for both, and for the oral BU group was 24% and 29%, respectively. Substituting i.v. for oral BU reduces variability in drug exposure and potentially improves toxicity as suggested by our finding of significantly less oral mucositis and decreased severity with i.v. BU.
BU 和 CY 是异基因造血祖细胞移植 (HPCT) 的常用预处理方案。静脉 BU 越来越多地用于替代口服制剂进行预处理。我们比较了在我们机构接受异基因 HPCT 的 135 例连续 AML 和骨髓增生异常综合征患者的结果，这些患者使用口服 (n=93) 或静脉 (n=42) BU 的 BUCY2 进行预处理，未进行剂量调整。静脉 BU 患者口腔粘膜炎任何严重程度的发生率较低（3%比 55%，P=0.002）和严重粘膜炎（3%比 24%，P=0.005）。两组间其他移植后结局相当。所有 26 例静脉 BU 和 33 例口服 BU 患者均存活；然而，口服 BU 组的中位随访时间明显更长。静脉 BU 患者的 1 年和 2 年非复发死亡率均为 21%，口服 BU 组分别为 23%和 29%。静脉 BU 患者的 1 年和 2 年复发死亡率均为 21%，口服 BU 组分别为 24%和 29%。静脉替代口服 BU 可减少药物暴露的变异性，并可能如我们发现静脉 BU 显著减少口腔粘膜炎和降低严重程度所表明的那样改善毒性。
