Fractionation of whole body irradiation before bone marrow transplantation for patients with leukaemia

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Abstract
Thirty patients in various stages of acute leukemia or chronic granulocytic leukemia (CGL) were treated with cytotoxic drugs followed by whole body irradiation (TBI) administered in 200 cGy [centigray] fractions twice daily to a total of 1000 or 1200 cGy. The immediate toxicity of fractionated TBI administered in this way was negligible; patients required only minor premedication and little treatment subsequently for complications attributable to TBI. Fourteen (47.degree.) patients have died (10 of the 12 [bone marrow] transplanted with active disease and 4 of the 18 subjected to [bone marrow] transplantation in remission of acute leukemia or in chronic phase of CGL). Though the duration of follow-up is still short, no patient in the latter group (follow-up of surviors ranging from 6-146 wk) has yet relapsed with any evidence of recurrent leukemia. This method of fracionating TBI apparently reduced toxicity for the patient without necessarily reducing its antileukemic effect. [TBI is routinely used to treat leukemia patients undergoing bone marrow transplantation because it induces sufficient immunosuppression to permit the hemopoietic stem cell allograft to survive and because it eradicates clonogenic leukemic cells.].