Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide-purged marrow for acute lymphoblastic leukemia.
Ten patients age 13-52 years with acute lymphoblastic leukemia (ALL) in first complete remission (CR) (1), second CR (6), or relapse (3) were treated with cyclophosphamide 50 mg/kg daily x 4 and total body irradiation 3 Gy daily x 4 followed by infusion of autologous marrow purged with 4-hydroperoxycyclophosphamide (4-HC) at 100-120 micrograms/ml. The patients transplanted in relapse also received 2 mg vincristine and corticosteroids. All marrows were harvested while patients were in CR. The nucleated marrow cell dose was 3.5 +/- 0.7 x 10(8)/kg, and the CFU-GM content of the transplant was 0.4 +/- 0.5 x 10(3)/kg after purging with 4-HC. Median time from transplantation is 48 months. The neutrophil count (ANC) exceeded 1.0 x 10(9)/L at a median of 26 days and platelets exceeded 50 x 10(9)/L at 34 days. All patients were in remission after transplantation (ABMT). Five patients relapsed 2-9 months after ABMT (actuarial rate 60%). Three patients are alive and in CR at 17+, 43+, and 54+ months after ABMT. Purging marrow with 4-HC did not adversely affect engraftment, but it is not clear if the high relapse rate was due to incomplete ex vivo purging or inadequacy of the conditioning regimen.
Gonzales-Chambers
R
R
Pittsburgh Cancer Institute Adult Bone Marrow Transplant Program, University of Pittsburgh.
Przepiorka
D
D
Shadduck
R K
RK
Borochovitz
D
D
Bloom
E J
EJ
Colvin
O M
OM
Mangan
K F
KF
Rosenfeld
C S
CS
D000293:Adolescent; D000328:Adult; D001853:Bone Marrow / Q000187:drug effects* / Q000473:pathology; D016026:Bone Marrow Transplantation / Q000379:methods; D003520:Cyclophosphamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006098:Granulocytes / Q000473:pathology; D006801:Humans; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery*; D012074:Remission Induction; D013234:Stem Cells / Q000473:pathology; D015996:Survival Rate; D014916:Whole-Body Irradiation
D003520:Cyclophosphamide; C011272:perfosfamide