BONE-MARROW TRANSPLANTATION FOR REFRACTORY ACUTE-LEUKEMIA IN 34 PATIENTS WITH IDENTICAL-TWINS

  • 1 January 1981
    • journal article
    • research article
    • Vol. 57  (3) , 421-430
Abstract
Patients (34) aged 4-67 yr (median 17 yr) with acute lymphocytic leukemia (ALL) (18 patients) or acute nonlymphocytic leukemia (ANL) (16 patients) who failed to enter complete remission (CR) or relapsed on conventional chemotherapy were treated with cyclophosphamide (CY), 60 mg/kg per day for 2 days, 1000 rad total body irradiation and a bone marrow transplant from a genotypically identical normal twin. Sixteen of the patients received additional chemotherapy within the week before CY. After the transplant, 23 patients received immunotherapy consisting of killed autologous leukemic cells and/or normal twin peripheral blood lymphocytes, 16 as part of a prospectively randomized study. One moribund patient died before engraftment. Nine patients (6 ALL, 3 ANL) continued to have detectable leukemic cells. Twenty-four patients (70%) achieved CR. One died of viral hepatitis at 1 mo. and another of viral interstitial pneumonitis at 4 mo. in CR. Fourteen patients (7 ALL, 7 ANL) relapsed 2-16 mo. (median 4) after transplantation. Eight patients (24%) (3 ALL, 5 ANL) remain in CR without any maintenance chemotherapy at 29-103 mo. (median 80) after the transplant. The end results were not significantly influenced by the type of leukemia, the immediate pre-CY chemotherapy or the immunotherapy. This approach, even when applied to endstage patients with acute leukemia in relapse, apparently causes tolerable morbidity, rare nonleukemic deaths and frequent remissions, some of which represent cures.