HIGH-DOSE CARMUSTINE, ETOPOSIDE AND MELPHALAN (BEM) WITH AUTOLOGOUS STEM-CELL TRANSPLANTATION - A DOSE-TOXICITY STUDY

We have investigated the toxicity of dose-escalation of BCNU, etoposid e and melphalan ('BEM') chemotherapy with autologous stem cell transpl antation in patients with haematological malignancies, Seventy-two pat ients with haematological malignancies were treated with BCNU (600 mg/ m(2), 450 mg/m(2) or 300 mg/m(2)), etoposide 2 g/m(2) and melphalan 14 0 mg/m(2) followed by autologous bone marrow transplantation (ABMT), n = 51, or autologous peripheral blood progenitor cell transplantation (APBPCT), n = 21, Liver and pulmonary function was monitored pretransp lant and at regular intervals post-transplant. Mucositis was graded da ily during in-patient stay, There was a significantly higher incidence of symptomatic pulmonary toxicity in the patients who received BCNU a t 600 mg/m(2) than in the other two groups, and there was a significan t increase in the incidence of asymptomatic decrease in carbon monoxid e (KCO) in the patients who received BCNU 450 mg/m(2), There was no si gnificant difference between the three groups in the incidence and sev erity of mucositis or in the incidence of transiently abnormal liver f unction, We conclude that etoposide at 2 g/m(2) can be used without un acceptable mucositis, BCNU at 600 mg/m(2) is associated with an unacce ptably high incidence of lung toxicity, but at 450 mg/m(2) there is mi nimal symptomatic lung toxicity.