Fractionated total body irradiation and high dose cyclophosphamide: a preparative regimen for bone marrow transplantation for patients with hematologic malignancies in first complete remission |
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Authors: | David S Snyder David O Findley Stephen J Forman Auayporn P Nademanee Margaret R O'Donnell Gerhard M Schmidt Philip J Bierman John L Fahey Robert A Krance Irena J Sniecinski Gottfried Doelken James A Lipsett Kenneth H Luk Mudra B Nathwani L Robert Hill Karl G Blume |
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Affiliation: | (1) Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, 1500 East Duarte Road, 91010 Duarte, CA, USA |
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Abstract: | Summary We treated 73 patients with hematologic malignancies in first complete remission (acute lymphoblastic leukemia = 23 patients; acute nonlymphoblastic 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.Abbreviations ALL
Acute lymphoblastic leukemia
- ANLL
Acute non-lymphoblastic leukemia
- AP
Anterior-posterior
- BMT
Bone marrow transplantation
- CML
Chronic myelogenous leukemia
- CMV
Cytomegalovirus
- CP
Chronic phase
- CR
Complete remission
- CSA
Cyclosporine A
- CY
Cyclophosphamide
- FTBI
Fractionated total body irradiation
- GVHD
Graft-versus-host disease
- IP
Interstitial pneumonia
- MTX
Methotrexate
- PA
Posterior-anterior
- Ph1
Philadelphia chromosome
- PSE
Prednisone
- TBI
Total body irradiation
- TLD
Thermoluminescent dosimetry
- UPN
Unique patient number
- WBC
White blood cell count
This work was supported by United States Public Health Service Grants CA 30206 and CA 33572 from the National Cancer Institute, DHHSSpecial Fellow of the Leukemia Society of America |
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Keywords: | Bone marrow transplantation Acute lymphoblastic leukemia Acute non-lymphoblastic leukemia Chronic myelogenous leukemia Non-Hodgkin's lymphoma High grade |
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