Marrow transplantation for acute nonlymphoblastic leukemia in first remission: toxicity and long-term follow-up of patients conditioned with single dose or fractionated total body irradiation.

Abstract

Seventy-five patients with acute nonlymphoblastic leukemia (ANL) in first remission were treated with cyclophosphamide, 60 mg/kg on each of two consecutive days followed by total body irradiation (TBI) at an exposure rate of 4-6 cGy/min from two opposing 60Co sources. The first 22 patients were given 9.2 Gy of TBI as a single dose. Subsequently 53 patients were randomized to receive either 10 Gy single dose TBI (n = 27) or 6 x 2 Gy fractionated TBI (n = 26). All patients received marrow transplants from HLA-identical siblings and all had sustained engraftment. Patients given 10 Gy of TBI had more early toxicity, especially veno-occlusive disease of the liver, than patients given 9.2 or 6 x 2 Gy of TBI. Idiopathic interstitial pneumonitis appeared to be more frequent in patients given 9.2 or 10 Gy single-dose TBI than in patients given 6 x 2 Gy fractionated TBI. Patients have now been followed from 5 to 9 years. Survival (+/- 95% confidence limits) at 5 years is 54 +/- 31% among patients given 9.2 Gy single dose TBI, 33 +/- 31% among patients given 10 Gy single dose TBI, and 54 +/- 26% among patients given 6 x 2 Gy fractionated TBI (P = 0.04). These results indicate that about half the patients with ANL transplanted while in first chemotherapy-induced remission can be expected to become long-term survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

• Authors: H J Deeg, K M Sullivan, C D Buckner, R Storb, F R Appelbaum, R A Clift, K Doney, J E Sanders, R P Witherspoon, E D Thomas
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 1 Issue 2 Pg. 151-7 (Dec 1986) ISSN: 0268-3369 [Print] England
• PMID: 3332129 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Cyclophosphamide

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Cyclophosphamide (therapeutic use)
• Follow-Up Studies
• Graft vs Host Disease (etiology, prevention & control)
• Hepatic Veno-Occlusive Disease (etiology)
• Humans
• Leukemia, Myeloid, Acute (mortality, therapy)
• Middle Aged
• Pulmonary Fibrosis (etiology)
• Quality of Life
• Random Allocation
• Recurrence
• Remission Induction
• Whole-Body Irradiation (adverse effects, methods)