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Allogeneic marrow transplantation in patients with acute myeloid leukemia
in first remission: a randomized trial of two irradiation regimens [see
comments]
RA Clift, CD Buckner, FR Appelbaum, SI Bearman, FB Petersen, LD Fisher, C Anasetti, P Beatty, WI Bensinger and K Doney
Fred Hutchinson Cancer Research Center, Veterans Administration Medical
Center, Seattle, WA 98104-2092.
A randomized trial of 12.0 Gy versus 15.75 Gy of total body irradiation
(TBI) was performed in patients with acute myeloid leukemia undergoing
allogeneic marrow transplantation while in first complete remission. All
patients received 120 mg/kg cyclophosphamide followed by TBI and marrow
from HLA-identical siblings. Cyclosporine and methotrexate were used for
prophylaxis against acute graft-versus-host disease (GVHD). Thirty-four
patients received 2.0-Gy fractions of irradiation daily for 6 days and 37
received 2.25-Gy fractions daily for 7 days. The 3-year actuarial
probabilities for relapse-free survival were 0.58 for the patients who
received 12.0 Gy and 0.59 for those who received 15.75 Gy. The 3-year
probabilities of relapse were 0.35 for the 12.0 Gy group and 0.12 for the
15.75 Gy group (P = .06). The 3-year probabilities of transplant-related
mortality were 0.12 and 0.32, respectively (P = .04). The probability of
moderate to severe acute GVHD was 0.21 for the 12.0 Gy group and 0.48 for
the 15.75 Gy group (P = .02). Patients exposed to the higher irradiation
dose received less immunoprophylaxis against, and had a higher incidence
of, acute GVHD. The increased dose of TBI significantly reduced the
probability of relapse but did not improve survival because of increased
mortality from causes other than relapse.
Volume 76,
Issue 9,
pp. 1867-1871,
11/01/1990
Copyright © 1990 by The American Society of Hematology
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