Abstract
The HiMEC conditioning regimen, consisting of melphalan (Mel), etoposide (VP16), and carboplatin (CBDCA), has been widely employed for high-dose chemotherapy against various pediatric solid tumors: however, fatal adverse effects, especially severe renal toxicity or infection, were sometimes observed after this regimen. In this study, we retrospectively analyzed the clinical outcome of 17 patients who underwent autologous transplantation using the HiMEC regimen. The incidence and severity of regimen-related adverse effects were compared between 9 patients treated with Mel after VP16 and CBDCA treatment (post-Mel group) and 8 patients before VP16 and CBDCA treatment (pre-Mel group). Compared with the pre-Mel group, the incidence of severe hypertension was significantly higher (0% vs 66.7%, p=0.009) and the incidence of severe renal toxicity tended to be higher, although not significantly, in the post-Mel group. By contrast, the duration of severe neutropenia was significantly longer [13 days (median, range 10–18) vs 10 days (median, range 8–14), p=0.028] and the incidence of severe mucositis was significantly higher (87.5% vs 33.3%, p=0.049) in the pre-Mel group. These results suggest that the preceding administration of Mel was recommended in most patients in consideration of the higher risk of renal toxicity and angiopathy caused by the subsequent administration of Mel. However, safer administration schedules of this regimen will be required to reduce the risk of infection and mucositis caused by the preceding administration of Mel.
