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Secondary failure of platelet recovery in patients treated with high-dose thiotepa and busulfan followed by autologous stem cell transplantation

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Abstract

Autologous stem cell transplantation (ASCT) with high-dose thiotepa and busulfan is a treatment option for patients with central nervous system (CNS) lymphoma. We report here the occurrence of secondary failure of platelet recovery (SFPR) in three out of 24 patients who received high-dose thiotepa and busulfan followed by ASCT. Although there was no obvious abnormality in the primary platelet engraftment as well as the recovery of other blood cells, they developed SFPR with a median time to onset of day 38, and the platelets gradually recovered over several months with steroid therapy. During the same period, there was no development of SFPR among 50 patients who received ASCT with a conditioning regimen of MEAM (ranimustine, etoposide, cytarabine, and melphalan) or high-dose melphalan. However, one of the two patients who received a conditioning regimen of busulfan and melphalan developed SFPR, suggesting that the use of a busulfan-based conditioning regimen may be one of the risk factors for SFPR. It is important to be aware of this possible adverse effect of ASCT with high-dose thiotepa and busulfan to ensure timely diagnosis and prevention of subsequent serious complications.

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Acknowledgements

The authors thank Dr. Maki Shindo and Ms. Megumi Oka, Department of Hematology/Oncology, Kyoto University, for their assistance in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Fumiya Wada, Momoko Nishikori, Masakatsu Hishizawa, Takero Shindo, Tadakazu Kondo & Akifumi Takaori-Kondo

  2. Department of Hematology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan

    Mitsumasa Watanabe

  3. Department of Hematology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan

    Akiko Aiba & Toshiyuki Kitano

  4. Department of Hematology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

    Yayoi Shimazu

Authors
  1. Fumiya Wada
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  2. Momoko Nishikori
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  3. Masakatsu Hishizawa
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  4. Mitsumasa Watanabe
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  5. Akiko Aiba
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  6. Toshiyuki Kitano
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  7. Yayoi Shimazu
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  8. Takero Shindo
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  9. Tadakazu Kondo
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  10. Akifumi Takaori-Kondo
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Corresponding author

Correspondence to Momoko Nishikori.

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Conflict of interest

M. Nishikori has received honoraria from Eisai and funding from Eisai and Sumitomo Dainippon Pharmaceutical. A. Takaori-Kondo has received honoraria from Bristol Myers Squibb, Celgene, Novartis, MSD, Kyowa Kirin, Astellas, and funding from Bristol Myers Squibb, Celgene, COGNANO, Ono, and Thyas, and has received research support from Astellas, Chugai, Eisai, Kim’s Korean Ginseng, Kyowa Kirin, Nippon Shinyaku, Ohara, Ono, Otsuka, Pfizer, Popuri, Takeda, and Sanofi. All other authors do not have any conflict of interest to declare.

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Wada, F., Nishikori, M., Hishizawa, M. et al. Secondary failure of platelet recovery in patients treated with high-dose thiotepa and busulfan followed by autologous stem cell transplantation. Int J Hematol 112, 609–613 (2020). https://doi.org/10.1007/s12185-020-03007-4

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  • DOI: https://doi.org/10.1007/s12185-020-03007-4

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