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Conditioning Regimens

The modification of high-dose therapy shortens the duration of neutropaenia by delay of leucocyte nadir

Bone Marrow Transplantation volume 37, pages 1087–1091 (2006)Cite this article

Abstract

Infections during neutropaenia contribute still significantly to mortality and morbidity after high-dose therapy and autologous stem cell transplantation. Further acceleration of haemopoietic recovery seems impossible for biological reasons. Another approach to shorten neutropaenia could be to remove drugs from high-dose therapy protocols with strong contribution to immunosuppression and neutropaenia and unproven antineoplastic activity. In this retrospective matched-pair analysis, conventional busulphan/cyclophosphamide (Bu/Cy) high-dose therapy was compared to single-agent busulphan conditioning before autologous stem cell transplantation. This modification led to a significant shorter neutropaenic interval by protraction of cell decrease and to a significant mitigation of neutropaenia. After single-agent busulphan conditioning, leucocytes dropped below 1/nl at median 1.5 days later when compared to the patients from the busulphanBu/Cy control group (P=0.001). In a significant percentage of patients (n=6, 60%) leucocytes did not fall below 0.5 cells/nl at any time. In contrast, all patients from the Bu/Cy control group experienced deep neutropaenia (P=0.004). Thrombocytopaenia and requirement for transfusions of platelets or red cells were not influenced. Antineoplastic activity seemed to be preserved as determined by survival analysis. In conclusion, modification of high-dose regimen with the intention to shorten neutropaenia with preserved antitumour activity could be an approach to reduce infection-related morbidity and mortality and to consider economic necessities.

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Acknowledgements

We thank Dr BP Jäger from the Department of Biostatistics for his advices and the nurses from the BMT unit for the excellent patient care.

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  1. Department of Internal Medicine C (Haematology and Oncology, Marrow Transplantation), Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany

    T Kiefer, W H Krüger, F Schüler, C Lotze, C Hirt & G Dölken

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  1. T Kiefer
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  2. W H Krüger
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  4. C Lotze
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Correspondence to W H Krüger.

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Kiefer, T., Krüger, W., Schüler, F. et al. The modification of high-dose therapy shortens the duration of neutropaenia by delay of leucocyte nadir. Bone Marrow Transplant 37, 1087–1091 (2006). https://doi.org/10.1038/sj.bmt.1705390

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