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High-dose cytosine arabinoside and fractionated total-body irradiation: an
improved preparative regimen for bone marrow transplantation of children
with acute lymphoblastic leukemia in remission
PF Coccia, SE Strandjord, PI Warkentin, NK Cheung, EM Gordon, LJ Novak, DC Shina and RH Herzig
Department of Pediatrics, Case Western Reserve University, Cleveland OH.
Twenty children with acute lymphoblastic leukemia in second (18 patients)
or third (two patients) complete remission after bone marrow relapse
received allogeneic bone marrow transplants from histocompatible sibling
donors. The preparative regimen for marrow transplantation consisted of 12
doses of 3,000 mg/m2 cytosine arabinoside twice daily for six days followed
by 1,200 cGy total-body irradiation (six doses of 200 cGy twice daily for
three days). The preparative regimen was well tolerated, and all patients
showed marrow engraftment promptly. Twelve patients are alive in complete
remission 12+ to 79+ months posttransplant; eight patients are over 48
months posttransplant. Six patients died 1 to 9 months posttransplant of
nonleukemic causes: (two each of graft-v-host disease, interstitial
pneumonitis, and infection). Two patients developed recurrent leukemia at
15 and 30 months posttransplant. Both have died at 19 and 36 months
posttransplant. Life table analysis reveals an actuarial survival and
event-free survival rate of 58% and a marrow relapse rate of 17%. These
results suggest that high-dose cytosine arabinoside and fractionated
total-body irradiation is a relatively nontoxic and highly effective
preparative regimen for allogeneic bone marrow transplantation for acute
lymphoblastic leukemia that deserves further evaluation.
Volume 71,
Issue 4,
pp. 888-893,
04/01/1988
Copyright © 1988 by The American Society of Hematology
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