MARROW TRANSPLANTATION FOR ACUTE NONLYMPHOBLASTIC LEUKEMIA IN 1ST REMISSION - TOXICITY AND LONG-TERM FOLLOW-UP OF PATIENTS CONDITIONED WITH SINGLE DOSE OR FRACTIONATED TOTAL-BODY IRRADIATION

  • 1 December 1986
    • journal article
    • research article
    • Vol. 1  (2) , 151-157
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 .times. 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 .times. 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 .times. 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 .times. 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. Chronic toxicity is acceptable. Results may vary dependent upon the preparative regimen; the optimum regimen remains to be defined.