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Blood, 15 April 2005, Vol. 105, No. 8, pp. 3035-3041.
Prepublished online as a Blood First Edition Paper on May 4, 2004; DOI 10.1182/blood-2003-07-2346.
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Submitted July 11, 2003
Accepted March 22, 2004
Chimerism and clinical outcomes of 110 unrelated donor bone marrow transplant recipients conditioned with low dose (550 cGy), single exposure total body irradiation and cyclophosphamide
M Girgis, C Hallemeier, W Blum, R Brown, HS Lin, H Khoury, LT Goodnough, R Vij, S Devine, M Wehde, S Postma, A Oza, J DiPersio, and D Adkins*
Dept. of Internal Medicine, Division of Oncology, Section of Bone Marrow Transplantation & Leukemia, Washington University School of Medicine, St. Louis, MO, USA
Dept. of Radiology, Division of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
Dept. of Internal Medicine, Division of Oncology, Section of Bone Marrow Transplantation & Leukemia, Washington University School of Medicine, St. Louis, MO, USA; Dept. of Pathology, Division of Laboratory Medicine, Washington University School of Medicine, St. Louis, MO, USA
* Corresponding author; email: kaddison{at}im.wustl.edu.
We hypothesized that low dose (550 cGy), single exposure, high dose rate (30 cGy/min) total body irradiation (TBI) with cyclophosphamide as conditioning for HLA compatible unrelated donor (URD) bone marrow transplantation (BMT) would result in donor chimerism (DC) with a low risk of serious organ toxicity and treatment-related mortality (TRM). Twenty-six patients with good risk diagnoses (acute leukemia in first CR and chronic phase CML) and 84 with poor risk diagnoses received this regimen and URD BMT. Unsorted marrow nucleated cells were assessed for chimerism using VNTR probes. 100% DC occurred in 78 of 91 (86%) evaluable patients at one or more follow-up points. Graft failure occurred in 7 patients (7.7%). Fatal organ toxicity occurred in only 2% of patients. TRM through two years of follow-up was 19% and 42% in those with good and poor risk diagnoses, respectively. Overall and disease-free survival in the good risk group were 47% and 40%, respectively, and in the poor risk group were 25% and 21%, respectively, at a median follow-up for living patients of 850 (range, 354-1588) days. This regimen resulted in 100% DC in most patients undergoing URD BMT with a relatively low risk of fatal organ toxicity and TRM.
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