Graft rejection and recovery of host-derived hematopoiesis after allogeneic bone marrow transplantation: relation to conditioning with high dose etoposide and total body irradiation.
Engraftment failure following allogeneic bone marrow transplantation (BMT) is rare in patients with acute leukemia, after frequent conditioning with marrow-lethal chemoradiotherapy. We evaluated the efficacy of a preparatory regimen consisting of fractionated total body irradiation (TBI) (12 Gy in six fractions) and high dose etoposide (60 mg/kg) administered as an 8-h infusion for allogeneic BMT in 16 consecutive patients with acute leukemia. Although 14 patients showed complete and sustained engraftment, the remaining two patients rejected bone marrow grafts from HLA-identical sibling donors and showed subsequent recovery of host-derived hematopoiesis. Despite the limited number of patients, this observation suggests that the immunosuppressive potential of etoposide may be inferior to that of cyclophosphamide (CY) and that etoposide as an alternative to CY as an antileukemic and immunosuppressive agent in allogeneic BMT may increase the risk of graft rejection.
Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama Japan.
M
M
Hara
K
K
Shinagawa
E
E
Omoto
K
K
Sunami
S
S
Deguchi
H
H
Narumi
K
K
Kojima
T
T
Azuma
H
H
Takamatsu
S
S
Nakao
M
M
Harada
D000208:Acute Disease; D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation; D005047:Etoposide / Q000008:administration & dosage*; D006084:Graft Rejection / Q000517:prevention & control; D006410:Hematopoiesis; D006801:Humans; D007938:Leukemia / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation
D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide