Toxicity
A total of 131 cycles (median: 2 cycles/patient; range: 1–10) were
administered. Thirty-five cycles required dose reduction for renal
damage, prolonged bone marrow suppression, and adjustment of schedule
with the subsequent stem cell transplant date. Grade IV hematological
toxicity included neutropenia in 127 cycles (97%), thrombocytopenia in
38 cycles (29%), and anemia in 3 cycles (2%). The median duration of
grade IV neutropenia was seven days (range: 2–31) with the use of G-CSF
support. The median number of transfusions for each cycle was 1 (range:
0–9) for red blood cells and 2 (range: 0–11) for platelets. Of the 43
patients, 35 (81%) required red blood cell transfusion and 37 (86%)
required platelet transfusion. Grade IV thrombocytopenia was more common
in relapsed cases than in primary cases (69% vs 14%, p< 0.001). Nonhematological toxicities of grade III/IV are
detailed in Table 3 . Three patients (2%) developed grade III
diarrhea, while none of the patients developed grade IV diarrhea. Fever
of ≥38°C occurred in 58 cycles (44%), and febrile neutropenia (FN)
occurred in 30 cycles (23%). Blood cultures were positive for bacteria
in six patients; three of these patients required removal of catheter to
control the infection (Table 3 ). Renal and liver damage
improved with conservative treatment.
Patients with UGT1A1 gene polymorphism showed a higher frequency
of grade IV leukopenia (64% vs. 94%) and neutropenia (94% vs. 100%)
compared to wild-type patients; however, there was no difference in the
frequency of grade III–IV diarrhea or FN.