Etoposide induces more severe mucositis than CY when added to TBI as conditioning in allograft recipients receiving CsA and MTX

Abstract

Fractionated TBI and etoposide (FTBI-VP16) conditioning is effective therapy for patients receiving allogeneic stem cell transplants for ALL. One of the major dose-limiting toxicities with this regimen is mucositis although its effect on patients and hospital resources is not well described. To determine the severity of mucositis (WHO grade 3-4) experienced and assess resource utilisation, we compared the non-haematological toxicities of 38 patients receiving FTBI-VP16 with 104 patients receiving CY and TBI (CYTBI). FTBI-VP16 patients were more likely to develop severe mucositis (odds ratio (OR) 6.0 (95% confidence interval (CI) 1.36, 54.42), P<0.01) and its duration was longer (11.5 vs 8 days, P<0.01). Resource utilisation was considerably higher especially in the use and duration of i.v. narcotics and parenteral nutrition, nursing care requirements and plt-transfusion support. Patients receiving FTBI-VP16 conditioning are ideal candidates for new therapies to prevent or reduce the severity of mucositis.