Allogeneic bone marrow transplantation after hyperfractionated total-body irradiation and cyclophosphamide in children with acute leukemia Journal Article

  

Authors:	Brochstein, J. A.; Kernan, N. A.; Groshen, S.; Cirrincione, C.; Shank, B.; Emanuel, D.; Laver, J.; O'Reilly, R. J.
Article Title:	Allogeneic bone marrow transplantation after hyperfractionated total-body irradiation and cyclophosphamide in children with acute leukemia
Abstract:	Ninety-seven children with either acute lymphoblastic leukemia (ALL) or acute myelogenous leukemia (AML) received HLA-identical bone marrow transplants from sibling donors, after preparation with 1320 cGy of hyperfractionated total-body irradiation and high-dose cyclophosphamide. Kaplan–Meier product–limit estimates (means ±SE) of disease-free survival at five years among patients with ALL in second remission, third remission, and fourth remission or relapse were 64±9, 42±14, and 23±11 percent, respectively, with probabilities of relapse of 13±7, 25±13, and 64±16 percent. Among patients with AML in first remission, second remission, and third remission or relapse, five-year disease-free survival estimates were 66±10, 75±15, and 33±19 percent, with respective relapse probabilities of 0, 13±12, and 67±19 percent. The most frequent cause of death in patients in early remission (ALL in second or third remission or AML in first or second remission) was bacterial sepsis, fungal sepsis, or both, most often in the presence of acute or chronic graft-versus-host disease. Among patients with ALL who received transplants while in second remission, the duration of the initial remission had no effect on the probability of relapse after transplantation. The only pretransplantation factor that significantly affected outcome was the disease status at the time of transplantation; patients in early remission had better disease-free survival. We conclude that transplantation after preparation with hyperfractionated total-body irradiation and cyclophosphamide is an effective mode of therapy in children with refractory forms of acute leukemia. (N Engl J Med 1987; 317:1618–24.), BONE marrow transplantation has been increasingly used as potentially curative therapy in children with refractory forms of acute leukemia.1 2 3 4 5 These forms include acute myelogenous leukemia (AML), in which historically the long-term disease-free survival has been at best 44 percent,6 and acute lymphoblastic leukemia (ALL) after relapse during chemotherapy.7 Dinsmore et al.8,9, (Memorial Sloan-–ettering Cancer Center) reported the results of conventional marrow transplantation in adults and children with acute leukemia who had been prepared for treatment by means of hyperfractionated total-body irradiation and cyclophosphamide. In those studies, the most important factor that predicted outcome was the disease status of the.... © 1987, Massachusetts Medical Society. All rights reserved.
Keywords:	child; acute granulocytic leukemia; major clinical study; cyclophosphamide; acute lymphoblastic leukemia; whole body radiation; graft versus host reaction; sepsis; bone marrow transplantation; fungus; human
Journal Title:	New England Journal of Medicine
Volume:	317
Issue:	26
ISSN:	0028-4793
Publisher:	Massachusetts Medical Society
Date Published:	1987-12-24
Start Page:	1618
End Page:	1624
Language:	English
DOI:	10.1056/nejm198712243172602
PUBMED:	3317056
PROVIDER:	scopus
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-0023499834&doi=10.1056%2fNEJM198712243172602&partnerID=40&md5=11e581147f79ed0bd02bec9ec0296805
Notes:	Article -- Export Date: 5 February 2021 -- Source: Scopus

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