Bone marrow transplantation with intensive combination chemotherapy/radiation therapy (SCARI) in acute leukemia.
Fifteen patients with acute leukemia resistant to standard chemotherapy were treated by bone marrow transplantation from HLA-matched siblings after conditioning with a new combination chemotherapy/radiation therapy regimen--SCARI. SCARI consists of 5 days of high-dose cytosine arabinoside and 6-thioguanine followed by 3 days of daunorubicin. After a rest period, cyclophosphamide and total-body irradiation are given sequentially. This regimen had acceptable morbidity. Median survival was 169 days. Overall survival and disease-free survival was 27% at over 11 months. Relapse rate was 13% of the entire group and 30% by actuarial projection. Relapses were late and initially extramedullary. Deaths from causes other than leukemia occurred early secondary to fungal infection and late secondary to interstitial pneumonia (frequently cytomegalovirus). Graft-versus-host disease and graft rejection were not causes of mortality. In these patients conditioned with SCARI, leukemic recurrences were infrequent but infectious complications were a major hazard.
D000293:Adolescent; D000328:Adult; D001854:Bone Marrow Cells; D016026:Bone Marrow Transplantation; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D003630:Daunorubicin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006087:Graft vs Host Reaction; D006801:Humans; D007938:Leukemia / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D007945:Leukemia, Lymphoid / Q000628:therapy; D007948:Leukemia, Monocytic, Acute / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013866:Thioguanine / Q000627:therapeutic use; D013997:Time Factors; D014184:Transplantation, Homologous
D003561:Cytarabine; D003520:Cyclophosphamide; D013866:Thioguanine; D003630:Daunorubicin