Two adult patients with T cell acute lymphoblastic leukemia (ALL) received an intensive multiagent therapeutic regimen and failed to enter remission. Following cytoreduction with cyclophosphamide (60 mg/kg x 2) and total body irradiation (1000 rads) they underwent bone marrow transplantation. One patient received marrow from his identical twin brother and the other from his HLA-matched sister. Both patients promptly went into remission. The identical twin recipient is alive and free of disease at 20-t months, but the allogeneic patient died of P. carinii pneumonia at eight months with no evidence of leukemia. These results suggest that even some refractory patients whose disease has multiple negative prognostic features may respond to pretransplant chemoradiotherapy and attain a clinically useful complete remission. Additional patients with longer follow-up will be necessary before the curative potential of bone marrow transplantation in T cell ALL can be assessed.
Cancer 452006-2008, 1980.
ONE MARROW TRANSPLANTATION has been advanced as a means of treating patients with hematological malignancies refractory to conventional therapy. However, persistent or recurrent leukemia continues to be a major cause of failure following a number of pretransplant cytoreductive regimens, including the combination of high-dose cyclophosphamide and supralethal total body irradiation (TBI)." It is not now possible to predict the sensitivity of a given patient's leukemia to a particular pretransplant protocol.
Although aggressive combination chemotherapy has resulted in prolonged disease-free remissions and probable cures in children with acute lymphoblastic leukemia,7 adult patients as a group do not enjoy as favorable an Furthermore, clinicopathological studies have demonstrated that patients whose blast cells have characteristics of T lymphocytes have a poor prognosis with a shorter remission duration4 and probably a lower induction rate.2
We have transplanted two adult patients with T cell ALL who have failed to respond to an intensive multi-