Conditioning with Busulfan. Etoposide-(VP16)-and Cyclophosphamide in AML in first remission
Relapse after allogeneic bone marrow transplantation remains a significant problem following standard conditioning regimens like Busulfan/Cyclophosphamide(Bu/ Cy) and Total body irradiation (TB1/ Cy). We added VP16 15 to 60 mg/kg body weight to Busulfan, 16 mg/ kg body weight and Cyclophosphamide 60 mg x2 in an effort to reduce the relapse rate. A loul of 31 patients were treated. Medium age 30 (4 to 51). AML type M 1: 1, M 2: 6, M 3: 0, M 4: 12, M 4eo: 5, M 5: 4, M 6: 4 not classified: one. Preceeding cycles of chemotherapy: 2.6 (1-5). Results: 25 patients survive in CCR (80.5%), 4 patients died of Graft versus host disease and infections, mucositis: one, sepsis: one. The total incidence of the clinical significant GvHD 2 to 4 was 14, 3 VOD's occured, but could be reversed with appropriate treatment. Conclusion The addition of VP16 to standard Bu/ Cy let to a disease free survival of 80% and no leukemic relapses. If the combination of Bu/ Cy/ VP16 is superior to Bu/ Cy should be explored in prospective studies.