Successful bone marrow transplantation in sensitized aplastic anemia patients using total lymphoid irradiation for conditioning: long-term follow-up.
Between June 1986 and November 1994, 22 previously transfused patients with severe aplastic anemia (SAA) were treated with high-dose cyclophosphamide (CY) (50 mg/kg over 4 consecutive days) and 7 Gy total lymphoid irradiation (TLI) in two fractions before allogeneic bone marrow transplantation (BMT) from HLA-identical sibling. Graft-versus-host-disease (GVHD) prophylaxis included the combination of methotrexate and cyclosporine A in all cases. Actuarial survival at 5 years is 73 +/- 9 per cent for the entire group and 86 +/- 13 per cent for the seven patients < or = 18 years. The incidence of graft failure was 0 per cent, and of acute GVHD and chronic GVHD was 31.5 per cent and 24 per cent respectively. Prolonged interval from diagnosis to BMT adversely influenced survival (P = 0.03). No hypothyroidism or secondary malignancies have been documented in this series. Our findings indicate that survival with CY-TLI is comparable to that obtained using preparative regimens without radiation. The changing role of radiotherapy in pretransplant immunosuppression for SAA is discussed.
Zapatero
A
A
Department of Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain.
Marín
A
A
López
M
M
Martín De Vidales
C
C
Cerezo
L
L
Domínguez
P
P
Pérez Torrubia
A
A
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000401:mortality / Q000628:therapy*; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation / Q000276:immunology; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008221:Lymphoid Tissue / Q000187:drug effects* / Q000528:radiation effects*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D019172:Transplantation Conditioning
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003520:Cyclophosphamide; D008727:Methotrexate