Fractionated total body irradiation and high dose cyclophosphamide: a preparative regimen for bone marrow transplantation for patients with hematologic malignancies in first complete remission.
We treated 73 patients with hematologic malignancies in first complete remission (acute lymphoblastic leukemia = 23 patients; acute non-lymphoblastic leukemia = 25 patients; chronic myelogenous leukemia in first chronic phase = 20 patients, and high grade lymphoma = five patients) with a uniform preparative regimen consisting of fractionated total body irradiation (1,320 cGy) and high dose cyclophosphamide (100 mg/kg), followed by allogeneic bone marrow transplantation. By radiation dosimetry we demonstrated that the calculated doses were delivered accurately and reproducibly. Actuarial survival rates (+/- SEM) in complete remission were as follows: Acute lymphoblastic leukemia = 74 +/- 9%; acute nonlymphoblastic leukemia = 50 +/- 11%; and chronic myelogenous leukemia = 55 +/- 11%. Actuarial relapse rates for these three diagnoses were 19 +/- 9%, 17 +/- 11%, and 0% respectively. Three of the five lymphoma patients are alive in complete remission at 22+, 28+, and 54+ months. Overall probability of survival for the 73 patients was 59 +/- 7%. Interstitial pneumonia, usually associated with cytomegalovirus infection and graft-versus-host disease, and relapse of the underlying malignancy were the major causes of death.
Snyder
D S
DS
Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA 91010.
Findley
D O
DO
Forman
S J
SJ
Nademanee
A P
AP
O'Donnell
M R
MR
Schmidt
G M
GM
Bierman
P J
PJ
Fahey
J L
JL
Krance
R A
RA
Sniecinski
I J
IJ
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007938:Leukemia / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D007945:Leukemia, Lymphoid / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy; D008223:Lymphoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy; D008297:Male; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D012074:Remission Induction; D014916:Whole-Body Irradiation / Q000379:methods*
D003520:Cyclophosphamide