Total body irradiation, cyclophosphamide, and etoposide with stem cell transplant as treatment for infants with acute lymphocytic leukemia

✍ Scribed by Pirich, Laura; Haut, Paul; Morgan, Elaine; Marymount, Maryann; Kletzel, Morris

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 71 KB
• Volume: 32
• Category: Article
• ISSN: 0098-1532
• DOI: 10.1002/(sici)1096-911x(199901)32:1<1::aid-mpo2>3.0.co;2-j

✦ Synopsis

Background:

Acute lymphoblastic leukemia (all) in infants has a very poor outcome with modern chemotherapy. we reviewed our experience with the infants diagnosed with all at children's memorial hospital from 1992 to 1997.

Procedure:

During this time period, 10 infants were diagnosed with all. seven of them were transplanted, four with marrow from hla-matched siblings and three with umbilical cord blood. four of the transplanted patients had the mll gene rearrangement and the other three transplanted patients had one or more other high-risk features including cd10-blasts, age less than 6 months at diagnosis, or prior relapse. the patients were conditioned with a regimen of total body irradiation (tbi), etoposide, and cyclophosphamide (cy). peritransplant toxicity was tolerable. the graft infused contained a median total nucleated cell dose/kg of 3 x 10(8) (.3 x 10(8)-6 x 10(8)). the median cd34+ cell dose/kg was 5 x 10(6) (.25 x 10(6)-31 x 10(6)).

Results:

All of the patients engrafted with a median of 18 days (11-29) to reach an absolute neutrophil count (anc) of 500/microliter. the median time to reach an unsupported platelet count greater than 20,000/microliter was 24 days (18-64). four of seven of the transplanted patients are leukemia-free survivors at a median follow-up of 775 days. of the three patients who were not transplanted, one is surviving 2+ years off therapy.

Conclusions:

Allogeneic stem cell transplant is an alternative to chemotherapy alone as a treatment for infant all when a suitable donor is available.