Marrow irradiation with high-dose 153Samarium-EDTMP followed by chemotherapy and hematopoietic stem cell infusion for acute myelogenous leukemia.
In four patients, aged 15 - 20 years, with high-risk acute myeloid leukemia (AML), high-dose samarium 153-labelled ethylenediaminetetramethylenephosphonate (153Sm-EDTMP) was used for targeted marrow irradiation before preparative chemotherapy conditioning regimens and allogeneic (three patients) or autologous (one patient) hematopoietic stem cell transplantation. The dose of 153Sm-EDTMP was 703 MBq/kg (n = 1) or 1110 MBq/kg (n = 3). No side-effects occurred during the 30-min infusion of 153Sm-EDTMP. Samarium - melphalan regimens were given to three patients; one had 153Sm-EDTMP - busulfan + cyclophosphamide. Total body radioactivity was below the 133 MBq safe limit before infusion of stem cells (day 14 after 153Sm-EDTMP). No hemorrhagic cystitis, nephrotoxicity or serious infections occurred. Leukocyte engraftment (white blood cell count >0.5 x 10(9)/l) occurred between 12 and 23 days after stem cell infusion (mean of 17 days). Complete cytogenetic and morphologic remission of AML was evident on follow-up marrow aspirate and biopsy specimens from all patients. In two of the four study patients, the disease remains in complete remission and the patients have an excellent quality of life (Eastern Cooperative Oncology Group performance status 0; no medications) and no organ toxicity more than 2 years and more than 4 years, respectively, after their blood and bone marrow transplantations. Thus, in adolescents and adults, 153Sm-EDTMP may provide a relatively simple and effective means for using irradiation to eliminate AML within the marrow.
Rodriguez
Vilmarie
V
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA. rodriguez.vilmarie@mayo.edu
Anderson
Peter M
PM
Litzow
Mark R
MR
Erlandson
Linda
L
Trotz
Barbara A
BA
Arndt
Carola A S
CA
Khan
Shakila P
SP
Wiseman
Gregory A
GA
D000293:Adolescent; D000328:Adult; D001853:Bone Marrow / Q000473:pathology / Q000528:radiation effects; D004307:Dose-Response Relationship, Radiation; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000532:radiotherapy* / Q000628:therapy; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D009943:Organophosphorus Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D011788:Quality of Life; D011868:Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use* / Q000633:toxicity; D012074:Remission Induction / Q000379:methods; D012493:Samarium / Q000008:administration & dosage / Q000627:therapeutic use* / Q000633:toxicity; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods
D009942:Organometallic Compounds; D009943:Organophosphorus Compounds; D011868:Radioisotopes; D012493:Samarium; C061972:samarium Sm-153 lexidronam