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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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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.

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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

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Authors and Affiliations

  1. Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, 1500 East Duarte Road, 91010, Duarte, CA, USA

    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

Authors
  1. David S. Snyder
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  2. David O. Findley
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  3. Stephen J. Forman
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  4. Auayporn P. Nademanee
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  5. Margaret R. O'Donnell
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  6. Gerhard M. Schmidt
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  7. Philip J. Bierman
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  8. John L. Fahey
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  9. Robert A. Krance
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  10. Irena J. Sniecinski
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  11. Gottfried Doelken
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  12. James A. Lipsett
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  13. Kenneth H. Luk
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  14. Mudra B. Nathwani
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  15. L. Robert Hill
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  16. Karl G. Blume
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Additional information

This work was supported by United States Public Health Service Grants CA 30206 and CA 33572 from the National Cancer Institute, DHHS

Special Fellow of the Leukemia Society of America

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Snyder, D.S., Findley, D.O., Forman, S.J. et al. Fractionated total body irradiation and high dose cyclophosphamide: a preparative regimen for bone marrow transplantation for patients with hematologic malignancies in first complete remission. Blut 57, 7–13 (1988). https://doi.org/10.1007/BF00320628

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  • DOI: https://doi.org/10.1007/BF00320628

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