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Maximum-tolerated dose of lomustine used in combination with etoposide and cyclophosphamide in conditioning regimen for hematopoietic stem cell transplantation in lymphoma patients

Bone Marrow Transplantation volume 57, pages 309–311 (2022)Cite this article

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Autologous hematopoietic stem cell transplantation (AHSCT) is indicated in different scenarios associated with Hodgkin (HL) and non-Hodgkin lymphomas (NHL) [1]. In the context of the shortage of drugs, which frequently occurs in Brazil, it is important to develop alternatives to traditional chemotherapy conditioning regimens.

Carmustine toxicity, and its unavailability in several countries, drives the search for alternative regimens, has relying on the association of different classes of drugs. Cyclophosphamide-based regimens were tested in lymphoma patients, based on the combination of 3 or 4 drugs with different pharmacokinetics and toxicity profile [2, 3]. Given the lack of evidence about the best conditioning regimen to be adopted in lymphomas, new regimens have been proposed to reduce toxicity and cost of conditioning regimen without compromising overall survival and progression-free survival. The maximum-tolerated dose (MTD) for previously tested combination of lomustine (CCNU), etoposide and cyclophosphamide in a 6-day regimen was 15 mg/kg [4]. In order to further develop a lomustine-based conditioning regimen of shorter duration [5, 6], we aimed at determining the optimal dose of lomustine, in a 5-day regimen, in association with etoposide and cyclophosphamide, at total fixed-doses of 1 and 6 g/m2, respectively.

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Authors and Affiliations

  1. Federal University of Juiz de Fora, Juiz de Fora, Brazil

    Christianne Tolêdo de Souza Leal, Raphael Barros Tavares & Abrahão Elias Hallack Neto

  2. University of Alabama at Birmingham, EUA, Birmingham, AL, USA

    Luciano José Megale Costa

  3. São Paulo University, São Paulo, Brazil

    Juliana Pereira

  4. Federal University of Ceará, Fortaleza, Brazil

    Fernando Barroso Duarte

  5. Monte Sinai Hospital, Juiz de Fora, Brazil

    Angelo Atalla

  6. São José Hospital, Teresópolis, Brazil

    Bruna Sousa Sabioni

Authors
  1. Christianne Tolêdo de Souza Leal
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  2. Luciano José Megale Costa
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  3. Juliana Pereira
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  4. Fernando Barroso Duarte
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  5. Raphael Barros Tavares
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  6. Angelo Atalla
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  7. Bruna Sousa Sabioni
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  8. Abrahão Elias Hallack Neto
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Contributions

CTdeSL—Main author, participated in the research elaboration, application of the consent form to patients, data collection and text writing. LJMC—Participated in the research elaboration, text writting and translation to English. JP—Participated in the research elaboration, ideas to the structure of the article. FBD—participated in the research elaboration, ideas to the structure of the article. RBT—Participated in the research elaboration, application of the consent form to patients, data collection and text writing. AA—Head of hematology at Monte Sinai Hospital- o research center that offered patient. BSS—Participated in the research elaboration, application of the consent form to patients, data collection. AEHN—Head of hematology service at University Hospital of the Federal University of Juiz de Fora. PhD adviser. Participated in the research elaboration, application of the consent form to patients, data collection and text writing.

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Correspondence to Christianne Tolêdo de Souza Leal.

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Leal, C.T.d.S., Costa, L.J.M., Pereira, J. et al. Maximum-tolerated dose of lomustine used in combination with etoposide and cyclophosphamide in conditioning regimen for hematopoietic stem cell transplantation in lymphoma patients. Bone Marrow Transplant 57, 309–311 (2022). https://doi.org/10.1038/s41409-021-01531-3

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