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The feasibility of using topotecan, vinorelbine, thiotepa and gemcitabine (TVTG) in adult patients with relapsed/refractory acute lymphoblastic leukaemia/lymphoma

Leukemia volume 22, pages 1627–1629 (2008)Cite this article

The success of haematopoietic stem cell transplantation depends upon the pretransplant leukaemic burden.1 In relapsed or refractory acute leukaemia and high-grade non-Hodgkin's lymphoma, the main aim is to decrease the leukaemic cell population to submicroscopic level so that consolidation with haematopoietic stem cell transplantation can be performed. In these heavily pretreated patients, there are issues of development of drug resistance and further risk of comorbidities from salvage chemotherapy. Thus for prolonged survival of such patients, a protocol that can induce disease remission to last long enough to perform haematopoietic stem cell transplantation and also prevent vital organ dysfunction is required.

Topotecan, vinorelbine, thiotepa and gemcitabine (TVTG) have been reported previously in children with relapsed or refractory leukaemia as institutional phase 2 non-randomized single-arm reinduction protocol.2 In the study reported by Kolb and Steinherz,2 28 children were treated with TVTG protocol, of which 13 (47%) achieved significant response with acceptable toxicities and 10 (36%) underwent haematopoietic stem cell transplantation. In view of these promising results in the children, we introduced TVTG regimen in adults who have been heavily pretreated for relapsed or refractory leukaemia and high-grade non-hodgkin's lymphoma. There is no report, to our knowledge in the literature, of TVTG being used in adults.

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Authors and Affiliations

  1. Division of Haematology-oncology, Royal Marsden Hospital, Sutton, Surrey, UK,

    P Hiwarkar, H-T Arkenau, J Treleaven, G Morgan, M Potter & M Ethell

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  1. P Hiwarkar
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  2. H-T Arkenau
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  3. J Treleaven
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  4. G Morgan
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  5. M Potter
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  6. M Ethell
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Correspondence to P Hiwarkar.

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Hiwarkar, P., Arkenau, HT., Treleaven, J. et al. The feasibility of using topotecan, vinorelbine, thiotepa and gemcitabine (TVTG) in adult patients with relapsed/refractory acute lymphoblastic leukaemia/lymphoma. Leukemia 22, 1627–1629 (2008). https://doi.org/10.1038/leu.2008.31

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