Fractionated total body irradiation and high dose cyclophosphamide: a preparative regimen for bone marrow transplantation for patients with hematologic malignancies in first complete remission

✍ Scribed by Snyder, David S. ;Findley, David O. ;Forman, Stephen J. ;Nademanee, Auayporn P. ;O'Donnell, Margaret R. ;Schmidt, Gerhard M. ;Bierman, Philip J. ;Fahey, John L. ;Krance, Robert A. ;Sniecinski, Irena J. ;Doelken, Gottfried ;Lipsett, James A. ;Luk, Kenneth H. ;Nathwani, Mudra B. ;Hill, L. Robert ;Blume, Karl G.

• Publisher: Springer-Verlag
• Year: 1988
• Weight: 707 KB
• Volume: 57
• Category: Article
• ISSN: 1432-0584
• DOI: 10.1007/bf00320628

✦ Synopsis

We treated 73 patients with hematologic malignancies in first complete remission (acute lymphoblastic leukemia = 23 patients; acute non-lymphoblastic leukemia = 25 patients; chronic myelogenous leukemia in first chronic phase = 20 patients, and high grade lymphoma = five patients) with a uniform preparative regimen consisting of fractionated total body irradiation (1,320 cGy) and high dose cyclophosphamide (100 mg/kg), followed by allogeneic bone marrow transplantation. By radiation dosimetry we demonstrated that the calculated doses were delivered accurately and reproducibly. Actuarial survival rates (+/- SEM) in complete remission were as follows: Acute lymphoblastic leukemia = 74 +/- 9%; acute nonlymphoblastic leukemia = 50 +/- 11%; and chronic myelogenous leukemia = 55 +/- 11%. Actuarial relapse rates for these three diagnoses were 19 +/- 9%, 17 +/- 11%, and 0% respectively. Three of the five lymphoma patients are alive in complete remission at 22+, 28+, and 54+ months. Overall probability of survival for the 73 patients was 59 +/- 7%. Interstitial pneumonia, usually associated with cytomegalovirus infection and graft-versus-host disease, and relapse of the underlying malignancy were the major causes of death.