Low toxicity of a conditioning with 8-Gy total body irradiation, fludarabine and cyclophosphamide as preparative regimen for allogeneic hematopoietic stem cell transplantation in pediatric hematological malignancies.
We here report the efficacy and toxicity of a conditioning regimen with fractionated 8-Gy TBI, fludarabine, and cyclophosphamide in allogeneic HSCT for pediatric hematological malignancies. Among 22 children who received related or unrelated HSCT, nine were transplanted with refractory disease and/or from HLA two or more loci-mismatched family donors. None of the patients developed graft failure. The Seattle grading system revealed that 18 patients had no RRT, and the remaining patients had grade I gastrointestinal toxicity alone. The estimated overall survival and leukemia-free survival at two yr were 57.1% and 48.0%, respectively, in 10 patients with acute lymphoblastic leukemia; 91.7% and 71.3%, respectively, in 12 patients with myeloid leukemia. The incidence of TRM was 4.8% at two yr. The rates of RRT above grade II and TRM in an 8-Gy TBI-containing regimen were significantly lower than the data of historical control patients who underwent 12-Gy TBI and cyclophosphamide with or without etoposide. The intermediate-dose TBI-based conditioning regimen may confer successful engraftment combined with minimized RRT, although its efficacy should be further evaluated.
Yanagisawa
Ryu
R
Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
Nakazawa
Yozo
Y
Sakashita
Kazuo
K
Tanaka
Miyuki
M
Shikama
Naoto
N
Kamijo
Takehiko
T
Shiohara
Masaaki
M
Koike
Kenichi
K
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000494:pharmacology / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005047:Etoposide / Q000494:pharmacology; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000737:chemistry; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000628:therapy*; D008297:Male; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014916:Whole-Body Irradiation
D006680:HLA Antigens; D005047:Etoposide; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine