Bone-Marrow Transplantation for Hematologic Neoplasia in 16 Patients with Identical Twins

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Abstract
Sixteen patients (11 years to 67 years of age) with hematologic neoplasia refractory to conventional therapy were treated with cyclophosphamide (60 mg per kilogram per day on two occasions), a supralethal dose of total-body irradiation (1000 rads) and a bone-marrow transplant from a normal identical twin. Twelve patients also received immunotherapy consisting of subcutaneous injections of the patients' own leukemia cells lethally irradiated with 10,000 rads and intravenous infusions of peripheral blood lymphocytes from the normal twin. Fourteen patients experienced complete remissions. Six patients (two with acute lymphoblastic leukemia, three with acute myelogenous leukemia, and one with lymphosarcoma-leukemia) remained in complete remission at 11 to 44 months without any maintenance chemotherapy, and two others with acute myelogenous leukemia were in complete remission at two and three months. One patient died of viral hepatitis without leukemia. Five patients relapsed at three to seven months. This approach can thus induce frequent and enduring remissions in end-stage patients. (N Engl J Med 290:1389–1393, 1974)