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Toxicological effects of fludarabine and treosulfan conditioning before allogeneic stem-cell transplantation

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Abstract

We studied early potential treosulfan-related toxicity in 118 patients treated with treosulfan-based conditioning before allogeneic hematopoietic stem-cell transplantation. Most patients (n = 93) had a hematological malignancy. In 80 cases, a HLA-A, -B and -DR matched unrelated donor was used, while 33 patients had a HLA-identical sibling donor, and five received an HLA-A, -B or -DR allele mismatched, unrelated donor. Levels of AST, ALT, and bilirubin were significantly increased 1 week after HSCT compared to before HSCT. However, only a few patients had transaminase levels >2 to 3 × the upper normal level. All patients became neutropenic; 61% were already so at the time of graft infusion. Nearly all patients engrafted, except for three who died very early. Non-relapse mortality was 7.5% at 100 days and 11.9% at 1 year after HSCT. Veno-occlusive disease of the liver occurred in one patient and hemorrhagic cystitis in two patients. This study shows that early regimen-related toxicity after HSCT was low despite similar marrow toxicities compared to myeloablative regimens.

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Acknowledgements

This study was supported by Grants from the Swedish Cancer Society (CF2014-2016), the Swedish Children’s Cancer Foundation (PR2013-0022, PR2015-0113 and KF2013-0011), the Marianne and Marcus Wallenbergs Foundation (2013.0117), the Foundation Olle Engkvist Byggmästare and grants provided by the Stockholm County Council (ALF-project 20140451).

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Authors and Affiliations

  1. Center for Allogeneic Stem Cell Transplantation Unit, Karolinska University Hospital, SE-141 86, Stockholm, Sweden

    Mats Remberger, Johan Törlen, Per Ljungman & Jonas Mattsson

  2. Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden

    Mats Remberger, Johan Törlen & Jonas Mattsson

  3. Department of Hematology, Karolinska University Hospital, Stockholm, Sweden

    Andreas Björklund & Per Ljungman

  4. Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden

    Andreas Björklund & Per Ljungman

  5. Blood Disorders, Immunodeficiency and Stem Cell Transplantation, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden

    Mikael Sundin

  6. Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

    Mikael Sundin

  7. Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden

    Karin Garming-Legert

  8. Experimental Cancer Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden

    Ibrahim El Serafi & Moustapha Hassan

Authors
  1. Mats Remberger
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  2. Johan Törlen
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  3. Ibrahim El Serafi
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  4. Karin Garming-Legert
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  5. Andreas Björklund
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  6. Per Ljungman
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  7. Mikael Sundin
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  8. Moustapha Hassan
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  9. Jonas Mattsson
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Corresponding author

Correspondence to Mats Remberger.

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The authors declare that they have no conflict of interest.

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Remberger, M., Törlen, J., Serafi, I.E. et al. Toxicological effects of fludarabine and treosulfan conditioning before allogeneic stem-cell transplantation. Int J Hematol 106, 471–475 (2017). https://doi.org/10.1007/s12185-017-2320-3

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  • DOI: https://doi.org/10.1007/s12185-017-2320-3

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