Conformation of cyclolinopeptide a observed by circular dichroism

A stereochemical investigation, by circular dichroism, of a synthetic nonapeptide (cyclolinopeptide A) in several organic and organic-sulfuric acid solvents is presented. From this examination, and results found for a conformationally rigid model compound, 1,7,7-trimethyl-3-azabicyclo [2.2.1] heptan-2-one(camphorolactam), it is concluded that cyclolinopeptide A may exist in several conformations in solution. None of these conformations is believed to be stabilized by intramolecular hydrogen bonds. Some details on an x-ray analysis of the cyclic nonapeptide are also presented.

Protected homo-oligopeptide structure: Model for preferred conformation of a linear methionine heptapeptide in chloroform

The (1)H nuclear magnetic resonance spectra for a protected linear heptapeptide of methionine, Boc-Met(7)-OMe, were measured in dimethyl-d(6) sulfoxide and C(2)HCl(3) solutions. In the former, the peptide is disordered. In C(2)HCl(3), preferred (short-range) interactions exist that dominate the overall secondary structure of the peptide. A model is proposed in which seven-membered ring structures are initiated at the NH(2)-terminus and propagate toward the carboxyl terminus. The first seven-membered ring contains a strong hydrogen bond between the amide NH of residue 2 and the carbonyl oxygen atom of the urethane blocking group. As one proceeds toward the carboxyl terminus the hydrogen bond strength of succeeding rings decreases, and at residue 5 the peptide chain assumes an extended structure that is stabilized by intermolecular hydrogen bonds. The model accounts for most of the results from (1)H NMR and infrared studies on the heptapeptide and is consistent with conformational energy calculations on homo-oligopeptides. It suggests that the COOH-terminal residues may serve as the nucleus for intermolecular peptide-peptide associations.

Comparison of vildagliptin and pioglitazone in patients with type 2 diabetes inadequately controlled with metformin

AIM

To compare the tolerability and efficacy of vildagliptin to pioglitazone as add-on therapy in patients with type 2 diabetes inadequately controlled with metformin monotherapy over 1-year duration.

METHODS

This 52-week, multicentre, randomized, active-controlled study compared vildagliptin (50 mg b.i.d., n = 295) and pioglitazone (30 mg daily, n = 281) in patients with inadequate glycaemic control [haemoglobin A1c (HbA(1c)) 7.5-11%] receiving a stable dose of metformin (>or=1500 mg). The primary objective was to demonstrate non-inferiority of vildagliptin at 24 weeks in the change in HbA(1c) from baseline. The objective of the additional 28 weeks of the study was to assess long-term safety, while also assessing mean change from baseline to study end in HbA(1c), fasting plasma glucose and body weight.

RESULTS

When added to a stable dose of metformin (mean baseline dose approximately 2 g/day), the non-inferiority of HbA(1c) lowering of vildagliptin to pioglitazone over 24 weeks was established at the non-inferiority margin of 0.3% (between-group difference = 0.1%). During the remaining 28 weeks, comparable HbA(1c) decreases were recorded in both groups. Overall adverse event (AE) rates were similar in both groups, as was the occurrence of peripheral oedema. Hypoglycaemia occurred rarely in both groups. Serious AEs occurred more frequently with pioglitazone group. While mean body weight increased significantly in the pioglitazone group (+2.6 kg) from baseline, there was no significant weight gain with vildagliptin (+0.2 kg).

CONCLUSIONS

When added to metformin, vildagliptin demonstrates favourable safety and tolerability over 1 year. Vildagliptin provided additional HbA(1c) lowering to that achieved with metformin alone and comparable to that achieved with pioglitazone, with only pioglitazone causing weight gain.

Vildagliptin plus metformin combination therapy provides superior glycaemic control to individual monotherapy in treatment-naive patients with type 2 diabetes mellitus

AIM

To compare the efficacy and safety of vildagliptin and metformin initial combination therapy with individual monotherapies in treatment-naive patients with type 2 diabetes mellitus (T2DM).

METHODS

This was a 24-week, randomized, double-blind, active-controlled study. Treatment-naive patients with T2DM who had a glycated haemoglobin (HbA(1c)) of 7.5-11% (N = 1179) were randomized equally to receive vildagliptin plus high-dose metformin combination therapy (50 mg + 1000 mg twice daily), vildagliptin plus low-dose metformin combination therapy (50 mg + 500 mg twice daily), vildagliptin monotherapy (50 mg twice daily) or high-dose metformin monotherapy (1000 mg twice daily). The primary objective was to demonstrate that HbA(1c) reduction from baseline with either combination therapy is superior to both monotherapies at the week 24 endpoint. Patients who failed glycaemic-screening criteria [HbA(1c )>11% or fasting plasma glucose (FPG) >15 mmol/l (270 mg/dl)] could enter a 24-week, single-arm substudy. These patients (N = 94) received open-label vildagliptin plus high-dose metformin combination therapy (100 mg + 1000 mg twice daily).

RESULTS

From comparable baseline values (8.6-8.7%), HbA(1c) decreased in all four treatment groups, to the greatest extent with vildagliptin plus high-dose metformin combination therapy. Mean (SE) HbA(1c) change from baseline was -1.8% (0.06%), -1.6% (0.06%), -1.1% (0.06%) and -1.4% (0.06%) with vildagliptin plus high-dose metformin combination therapy, vildagliptin plus low-dose metformin combination therapy, and vildagliptin and metformin monotherapies respectively. The between-group difference was superior with vildagliptin plus high-dose metformin combination therapy (p < 0.001 vs. both monotherapies) and vildagliptin plus low-dose metformin combination therapy (p < 0.001 and p = 0.004, vs. vildagliptin and metformin monotherapies, respectively). Higher baseline HbA(1c) values were linked to greater HbA(1c) reductions, with changes of -3.2% (0.22%), -2.7% (0.22%), -1.5% (0.24%) and -2.6% (0.26%) respectively, occurring in patients with baseline HbA(1c)>or=10%. Reductions in FPG were superior with vildagliptin plus high-dose metformin combination therapy [change from baseline -2.63 (0.13) mmol/l] compared with both monotherapies [-1.26 (0.13) mmol/l and -1.92 (0.13) mmol/l, respectively; p < 0.001]. There was no incidence of hypoglycaemia or severe hypoglycaemia with either combination therapy, and neither was associated with weight gain. All treatments were well tolerated and displayed a comparable incidence of adverse events overall. Despite superior HbA(1c) lowering, the vildagliptin plus low-dose metformin combination therapy group demonstrated a favourable gastrointestinal (GI) tolerability profile compared with metformin monotherapy.

CONCLUSIONS

In treatment-naive patients, combinations of vildagliptin and both high-dose and low-dose metformin provide superior efficacy to monotherapy treatments with a comparable overall tolerability profile and low risk of hypoglycaemia. The potential dose-sparing effect of adding vildagliptin to low-dose metformin in preference to the up-titration of metformin may allow patients to achieve equivalent or superior HbA(1c) lowering without the GI tolerability issues associated with higher doses of metformin.

Efficacy and tolerability of vildagliptin in patients with type 2 diabetes inadequately controlled with metformin monotherapy

The aim of the study was to evaluate the efficacy and safety of vildagliptin added to metformin in patients with type 2 diabetes mellitus. A multicentre, double-blind, randomized, placebo-controlled, 24-week study in patients inadequately controlled with metformin (HbA(1c) 7.5-11%) was designed. Patients were randomized to vildagliptin (Galvus) 100 mg given in the morning (AM), vildagliptin 100 mg given in the evening (PM), or placebo. The primary objective was to demonstrate that HbA(1c) reduction with once-daily vildagliptin 100 mg AM dosing is superior to placebo. Change from baseline to study endpoint in adjusted mean (SE) HbA(1c) improved significantly with vildagliptin AM dosing (-0.66 [0.11] versus 0.17% [0.11] with placebo; p <0.001). Subgroup analyses revealed that HbA(1c) reduction from baseline was greatest in those patients who had the highest baseline HbA(1c) levels. According to a predefined set of response criteria, the percentage of responder patients was significantly greater in the vildagliptin AM dosing group than in the placebo group for all responder definitions. Further analysis also revealed comparable efficacy between AM and PM dosing. Body weight remained generally stable in the combined vildagliptin group (+0.06 kg) and decreased with placebo (-0.69 kg); the incidence of adverse events was similar with vildagliptin AM dosing and placebo (30.4 and 34.4%, respectively). Vildagliptin 100 mg given as a morning dose is an effective and well-tolerated treatment option in patients with type 2 diabetes mellitus inadequately controlled with metformin monotherapy, and is equally efficacious when given as either a morning or evening dose.

Validating genetic risk associations for ovarian cancer through the international Ovarian Cancer Association Consortium

The search for genetic variants associated with ovarian cancer risk has focused on pathways including sex steroid hormones, DNA repair, and cell cycle control. The Ovarian Cancer Association Consortium (OCAC) identified 10 single-nucleotide polymorphisms (SNPs) in genes in these pathways, which had been genotyped by Consortium members and a pooled analysis of these data was conducted. Three of the 10 SNPs showed evidence of an association with ovarian cancer at P< or =0.10 in a log-additive model: rs2740574 in CYP3A4 (P=0.011), rs1805386 in LIG4 (P=0.007), and rs3218536 in XRCC2 (P=0.095). Additional genotyping in other OCAC studies was undertaken and only the variant in CYP3A4, rs2740574, continued to show an association in the replication data among homozygous carriers: OR(homozygous(hom))=2.50 (95% CI 0.54-11.57, P=0.24) with 1406 cases and 2827 controls. Overall, in the combined data the odds ratio was 2.81 among carriers of two copies of the minor allele (95% CI 1.20-6.56, P=0.017, p(het) across studies=0.42) with 1969 cases and 3491 controls. There was no association among heterozygous carriers. CYP3A4 encodes a key enzyme in oestrogen metabolism and our finding between rs2740574 and risk of ovarian cancer suggests that this pathway may be involved in ovarian carcinogenesis. Additional follow-up is warranted.

Synthesis and biologic activity of conformationally constrained analogs of L-363,301

We report the synthesis, biological activity and conformational analysis of analogs of the cyclic hexapeptide L-363,301, c[Pro6-Phe7-D-Trp8-Lys9-Thr10-Phe11] (numbering as in the native hormone somatostatin-14). The d-Trp in position 8 was replaced with (2R,3S)- and (2R,3R)-beta-MeTrp respectively, with an added methyl group in the beta position of Trp. The objective of our study was to determine the potency and selectivity generated by the added constraint in the beta position of the d-Trp upon binding to human somatostatin receptors hsst1-5. We synthesized the building blocks enantioselectively and incorporated them into the peptides by SPPS. Competition binding assays revealed that both compounds 2 and 3 were selective for hsst2 over hsst5. The (2R,3S) analog 2 was approximately 30 times more potent at hsst2 than the (2R,3R) analog 3. Interestingly, the (2R,3R) compound showed no binding affinity at hsst5.

Circumcision and human papillomavirus infection in men: a site-specific comparison

BACKGROUND

Lack of circumcision has been identified as a risk factor for male genital human papillomavirus (HPV) infection, although this association has not been consistently supported.

METHODS

Specimens for HPV testing were collected from a cohort of 379 (primarily heterosexual) adult males. HPV prevalence in the glans penis and coronal sulcus, penile shaft, scrotum, semen, and urine was compared by circumcision status.

RESULTS

Overall, HPV DNA prevalence ranged from 6% in semen to 52% in the penile shaft. The prevalence of any HPV infection in the glans/corona was significantly higher in uncircumcised men (46%) than in circumcised men (29%) (odds ratio [OR], 1.96 [95% confidence interval (CI), 1.02-3.75], adjusted for demographic characteristics and sexual history). Uncircumcised men also had an increased risk of oncogenic HPV infection (adjusted OR, 2.51 [95% CI, 1.11-5.69]) and infection with multiple HPV types (adjusted OR, 3.56 [95% CI, 1.50-8.50]). Among uncircumcised men, HPV prevalence in the foreskin (44%) was comparable to that in the glans/corona, and type-specific positivity was observed between the 2 sites (kappa=0.52).

CONCLUSIONS

Uncircumcised men have an increased risk of HPV infection, including with oncogenic HPV, specifically localized to the glans/corona, possibly because of its proximity to the foreskin, which may be particularly vulnerable to infection.

Human epidermal growth factor receptor-2 and estrogen receptor expression, a demonstration project using the residual tissue repository of the Surveillance, Epidemiology, and End Results (SEER) program

BACKGROUND

In 2001, the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program established Residual Tissue Repositories (RTR) in the Hawaii, Iowa, and Los Angeles Tumor Registries to collect discarded tissue blocks from pathologic laboratories within their catchment areas. To validate the utility of the RTR for supplementing SEER's central database, we assessed human epidermal growth factor receptor-2 (HER2) and estrogen receptor expression (ER) in a demonstration project.

MATERIALS

Using a prepared set of tissue microarrays (TMAs) residing in the Hawaii Tumor Registry (HTR), we performed standard immunohistochemistry. Breast cancers in the TMA were diagnosed in 1995, followed through 2006, and linked to SEER's main database.

RESULTS

The TMA included 354 cases, representing 51% of 687 breast cancers in the HTR (1995). The HTR and TMA cases were similar with respect to patient demographics and tumor characteristics. Seventy-six percent (76%, 268 of 354) of TMA cases were HER2+ and/or ER+, i.e., 28 HER2+ER-, 12 HER2+ER+, and 228 HER2-ER+. There were 67 HER2-ER- cases and 19 were unclassified. Age distributions at diagnosis were bimodal with dominant early-onset modes for HER2+ER- tumors and dominant late-onset modes for HER2-ER+ breast cancers. Epidemiologic patterns for concordant HER2+ER+ (double-positive) and HER2-ER- (double-negative) were intermediate to discordant HER2+ER- and HER2-ER+.

CONCLUSION

Results showed contrasting incidence patterns for HER2+ (HER2+ER-) and ER+ (HER2-ER+) breast cancers, diagnosed in 1995. Though sample sizes were small, this demonstration project validates the potential utility of the RTR for supplementing the SEER program.

Autologous transplantation for relapsed non-Hodgkin lymphoma using intravenous busulfan and cyclophosphamide as conditioning regimen: A single center experience

18508

Background: High-dose chemotherapy followed by autologous stem cell transplanatation has become standard of care for patients with relapsed, chemosensitive non-Hodgkin’s lymphoma (NHL). In an effort to improve safety and efficacy of this therapeutic approach, new conditioning regimens are being developed. Methods: We retrospectively reviewed the clinical data of 44 consecutive patients with relapsed NHL who had been treated with intravenous Busulfan and Cyclophosphamide (BU/CY) as conditioning regimen for autologous stem cell transplantation between January 2000 and April 2005. Busulfan was administered at a total dose of 3.2 mg/kg on days -7 to -4 (given in two or four divided doses), followed by Cyclophosphamide at a dose of 120 mg/kg intravenously on days -3 and -2. We determined treatment-related morbidity and mortality, event-free survival (EFS, defined as time period between transplantation and occurrence of serious morbidity, disease relapse, disease progression, or death), disease-free survival (DFS), and overall survival (OS). Results: The distribution by histologic type of the 44 patients was as follows: 29 diffuse large B-cell lymphoma, 8 follicular lymphoma, 4 mantle cell lymphoma, and 3 peripheral T-cell lymphoma. Median age was 50 (range 20 to 68 years). At the time of transplantation, 27 patients had attained a complete response (CR or CRu) to salvage chemotherapy, 13 had achieved a partial response, and 4 had stable disease. Median time to neutrophil recovery post transplantation was 11 days. Treatment-related toxicities included nausea/vomiting (77%), diarrhea (43%), and mucositis (66%), which were mild in the majority of cases. Neutropenic fever occurred in 82% of patients. The 100-day mortality rate was 4 (9%) of patients: sepsis (n=1), pneumonia (n=1), and hepatic veno-occlusive disease (n=2). After a median follow-up of 52 months, 3-year Kaplan-Meier estimates of EFS, DFS, and OS were 35%, 41% and 44% respectively. Conclusions: Intravenous BU/CY is a safe and effective conditioning regimen as part of autologous transplantation for relapsed NHL. Our outcomes are comparable to those of other published regimens. Further investigation of this treatment approach is warranted.

No significant financial relationships to disclose.

Early termination of adjuvant therapy for breast and colorectal cancers

6610

Background. Recent patterns-of-care studies report that cancer patients often do not complete prescribed therapy, with potentially important implications for clinical outcomes including survival. Yet, little is known about the frequency and determinants of early treatment discontinuation. The aims of this study were to address these issues in a largely rural population of a 33-county region of southwest Georgia. Methods. A total of 3,996 cases of breast, colorectal (CRC), lung, and prostate cancer diagnosed between 2001 and 2003 were identified from the Georgia Comprehensive Cancer Registry, with data collected from medical records by trained abstractors; 3,949 cases were available for analysis. Since completion of adjuvant chemotherapy with a goal of cure may be particularly important, this report focuses on cases treated for stage I and II breast cancer and stage III CRC. Results. Among 854 stage I-II breast cancer cases, 323 (38%) received chemotherapy. In 293 of those cases, treatment was stopped within the first year post-diagnosis. The primary reasons for stopping included treatment completion (86%), significant toxicity (8%), or other clinical reasons (2%). In only seven cases (2%) was treatment discontinued due to patient factors (e.g. refusal or did not return to clinic). Among 179 stage III CRC cases, 124 (69%) received adjuvant chemotherapy; in 117 cases chemotherapy was stopped within 12 months following diagnosis. Clinical reasons for stopping chemotherapy in those 117 cases included treatment completion (67%), toxicity (12%), disease progression (8%), or death (3%). In only 4% of cases was chemotherapy discontinued due to patient refusal, and in 3% of cases a patient was lost to follow up. Conclusions. In this largely rural population, only a small proportion of cases stopped adjuvant chemotherapy early due to patient-attributable factors; most treatment termination was due to clinical indications. Review of practice patterns using only administrative data may not reveal the actual reasons for treatment discontinuation. Further study of underlying factors of early termination is needed to design appropriate interventions to promote completion of prescribed therapy.

No significant financial relationships to disclose.

Descriptive study of gallbladder, extrahepatic bile duct, and ampullary cancers in the United States, 1997-2002

OBJECTIVE

Few investigations of biliary tract (gallbladder, extrahepatic bile duct, ampulla of Vater) cancers have been conducted because of the relative rarity of these malignancies. The objective of this analysis was to compare the demographic, pathological, and clinical features of biliary tract cancers among men and women.

METHODS

Biliary tract cancers among 11,261 men and 15,722 women were identified through 33 US population-based registries during the period 1997-2002. These registries were estimated to represent 61% of the US population. Age-adjusted incidence rates (AAIR) were calculated per 100,000 population using counts derived from the 2000 US census.

RESULTS

The AAIR for gallbladder cancer among men (0.82 per 100,000) was significantly lower than the AAIR among women (1.45 per 100,000). By contrast, rates for extrahepatic bile duct and ampullary cancers were significantly higher among men (0.93 per 100,000 and 0.70 per 100,000, respectively) than among women (0.61 per 100,000 and 0.45 per 100,000, respectively). White men and women had significantly lower AAIRs for gallbladder cancer compared with other racial-ethnic groups, with the highest rates among Hispanics, American Indian-Alaska Natives, and Asian-Pacific Islanders. Asian-Pacific Islanders and Hispanics of both sexes had the highest AAIRs for extrahepatic bile duct and ampullary cancers. Ampullary tumors were more likely to be diagnosed at a localized or regional stage than were cancers of the gallbladder and extrahepatic bile duct. Asian-Pacific Islander men and women tended to have more unstaged cancers than other groups.

CONCLUSIONS

This population-based study suggests distinct etiologies of anatomic subsites of biliary tract cancer and caution against analytic investigations of all biliary tract cancers combined.

Lack of survival benefit of post-operative radiation therapy in prostate cancer patients with positive lymph nodes

Randomized data from SWOG 8794 and EORTC 22911 confirm the benefit of post-operative radiation therapy (RT) for selected patients with pT3 prostate cancer (CaP) after radical prostatectomy (RP). However, data regarding the potential benefit of RT for patients post-RP with positive lymph node (+LN) involvement are limited. We analyzed the Surveillance Epidemiology End Results (SEER) registry for population-based data on efficacy of post-operative RT for +LN patients after RP. As LN data have only been captured by SEER since 1988, we analyzed data for 1988-1992, with specific attention to 10-year relative survival (defined as observed survival divided by the survival of a gender-, age- and race-matched population cohort without disease). Specifically analyzed were data for 1921 patients with nonmetastatic prostate cancer who underwent surgery alone, or surgery followed by RT, and who had +LNs documented. SEER does not code the interval between surgery and RT, so the ratio of patients receiving salvage versus adjuvant therapy is unknown. Using follow-up data through 2002, post-diagnosis survival was examined by number of +LNs. There was no significant relative survival benefit for +LN patients receiving post-operative RT (chi(2)P=0.270). These data do not support routine use of post-operative RT for patients with +LNs in the surgical specimen.

Occupational trichloroethylene exposure and non-Hodgkin's lymphoma: a meta-analysis and review

METHODS

Meta-analysis and review of 14 occupational cohort and four case-control studies of workers exposed to trichloroethylene (TCE) to investigate the relation between TCE exposure and the risk of non-Hodgkin's lymphoma (NHL). Studies were selected and categorised based on a priori criteria, and results from random effects meta-analyses are presented.

RESULTS

The summary relative risk estimates (SRRE) for the group of cohort studies that had more detailed information on TCE exposure was 1.29 (95% CI 1.00 to 1.66) for the total cohort and 1.59 (95% CI 1.21 to 2.08) for the seven studies that identified a specific TCE exposed sub-cohort. SRREs for three studies with cumulative exposure information were 1.8 (95% CI 0.62 to 5.26) for the lowest exposure category and 1.41 (95% CI 0.61 to 3.23) for the highest category. Comparison of SRREs by levels of TCE exposure did not indicate exposure-response trends. The remaining cohort studies that identified TCE exposure but lacked detailed exposure information had an SRRE of 0.843 (95% CI 0.72 to 0.98). Case-control studies had an SRRE of 1.39 (95% CI 0.62 to 3.10). Statistically significant findings for the Group 1 studies were driven by the results from the subgroup of multiple industry cohort studies (conducted in Europe) (SRRE = 1.86; 95% CI 1.27 to 2.71). The SRRE for single industry cohort studies was not significantly elevated (SRRE = 1.25; 95% CI 0.87 to 1.79).

CONCLUSIONS

Interpretation of overall findings is hampered by variability in results across the Group 1 studies, limited exposure assessments, lack of evidence of exposure response trends, lack of supportive information from toxicological and mechanistic data, and absence of consistent findings in epidemiologic studies of exposure and NHL. Although a modest positive association was found in the TCE sub-cohort analysis, a finding attributable to studies that included workers from multiple industries, there is insufficient evidence to suggest a causal link between TCE exposure and NHL.

Salvage prostatectomy for prostate cancer (CaP): Data from the Surveillance Epidemiology and End Results (SEER) database

4622

Recent randomized data have established adjuvant radiation therapy (RT) as a standard of care approach for appropriately selected high-risk CaP patients after radical prostatectomy (RP). However, data on salvage prostatectomy (SP; defined here as radical prostatectomy, total prostatectomy, and cystoprostatectomy) after definitive RT are available only in single-institution reports of limited patient numbers. We analyzed data from the SEER database for the period 1988–1997. Specifically analyzed were data for patients undergoing various combinations of surgery and RT with or without hormonal therapy (HT; defined as medications, surgical castration or both) for localized (Stage I/II) CaP. Patients with multiple primary cancers were excluded. Demographic data for each case included age and diagnosis, race and year of diagnosis. Cancer-related variables included SEER summary stage and grade. Treatment information included surgery, RT, HT, and sequence of surgery with radiation. Using follow-up data through 2002, post diagnosis observed survival (OS) and relative survival (RS; defined as observed survival divided by that expected in a national age-, gender-, and race-matched cohort) was examined in four treatment groups: 44 patients with RT prior to SP, 1376 patients with RT following RP, 36344 patients with RP alone, and 30717 patients with RT alone. Mortality across treatment categories was compared using a Cox proportionate hazard model controlling for age, year of diagnosis, race, HT, SEER registry, and grade. Although infrequently performed, SP provides for 10-year relative survival of 82%. After controlling for potential confounding factors, data for RT followed by SP showed no appreciable benefit compared to RT alone.

[Table: see text]

No significant financial relationships to disclose.

Intravenous busulfan and cyclophosphamide as an autologous transplant conditioning regimen for relapsed non-Hodgkin’s lymphoma

16508

Purpose: High-dose chemotherapy and hematopoietic stem cell transplantation has become the standard of care for chemosensitive relapsed Non-Hodgkin’s Lymphoma. Multiple conditioning regimens including CBV, BEAM, and BEAC have been used in the past with success. Limitations on the supply of carmustine have made it important to find other effective conditioning regimens. Methods: We retrospectively evaluated the use of intravenous Busulfan and Cyclophosphamide (IV Bu/Cy) as a conditioning regimen for autologous stem cell transplantation in Non-Hodgkin’s Lymphoma patients. Patients were given Busulfan 3.2 mg/kg total intravenously on days -7 to -4 (either once daily or in 2 or 4 divided doses) followed by Cyclophosphamide 120 mg/kg intravenously on days -2 and -1. Results: Forty-four patients, ages 20 to 68 years (median 50) were treated from January 2000 to April 2005. Most patients had diffuse large B-cell lymphoma (n = 29). Of the remaining patients, 8 had follicular lymphoma, 4 had mantle cell lymphoma and 3 had peripheral T-cell lymphoma. At the time of transplant, 27 patients had attained a complete response (CR or CRu) to salvage chemotherapy, 13 patients had achieved a partial response, and 4 had stable disease. The patients received a median of 3.0 × 106 CD34+ cells/kg (range 1.3–16.6 × 106). There were 4 treatment-related deaths by day 100: 1 from sepsis, 1 from pneumonia, and 2 from veno-occlusive disease (VOD). With a median follow-up of 42 months, 3-year Kaplan-Meier estimates of event free and overall survival for the entire cohort were 44% and 45%. For the patients that attained a CR or CRu prior to transplant, the EFS and OS were 42% and 53%, respectively. Conclusions: IV Bu/Cy is a safe and effective conditioning regimen. Due to the incidence of VOD, this regimen should be used with caution in patients with pre-existing hepatic dysfunction. Overall, our outcomes are comparable to that of other published regimens. Further investigation of Busulfan with Cyclophosphamide or with other chemotherapy combinations is warranted.

No significant financial relationships to disclose.