scholarly journals Allogeneic marrow transplantation for children with juvenile chronic myelogenous leukemia

Blood ◽  
1988 ◽  
Vol 71 (4) ◽  
pp. 1144-1146 ◽  
Author(s):  
JE Sanders ◽  
CD Buckner ◽  
ED Thomas ◽  
R Fleischer ◽  
KM Sullivan ◽  
...  
Keyword(s):  
Chronic Myelogenous Leukemia ◽  
Total Body Irradiation ◽  
Marrow Transplantation ◽  
Family Members ◽  
Myelogenous Leukemia ◽  
Allogeneic Marrow Transplantation ◽  
Total Body ◽  
Allogeneic Marrow

Abstract Fourteen children between the ages of 2 and 5 years with juvenile chronic myelogenous leukemia were given cyclophosphamide, total-body irradiation, and marrow transplants. Unmodified marrow was given to six patients who received marrow from HLA-identical siblings and eight patients who received marrow from family members HLA identical for one haplotype but mismatched for one to three loci on the nonshared haplotype. Five patients died of transplant-related complications, and three relapsed at 48, 81, and 1,670 days posttransplant and died of leukemia. Six patients survive in continuous remission from 0.5 to 11.5 years posttransplant.

scholarly journals Allogeneic marrow transplantation for children with juvenile chronic myelogenous leukemia

Blood ◽  
1988 ◽  
Vol 71 (4) ◽  
pp. 1144-1146 ◽  
Author(s):  
JE Sanders ◽  
CD Buckner ◽  
ED Thomas ◽  
R Fleischer ◽  
KM Sullivan ◽  
...  
Keyword(s):  
Chronic Myelogenous Leukemia ◽  
Total Body Irradiation ◽  
Marrow Transplantation ◽  
Family Members ◽  
Myelogenous Leukemia ◽  
Allogeneic Marrow Transplantation ◽  
Total Body ◽  
Allogeneic Marrow

Fourteen children between the ages of 2 and 5 years with juvenile chronic myelogenous leukemia were given cyclophosphamide, total-body irradiation, and marrow transplants. Unmodified marrow was given to six patients who received marrow from HLA-identical siblings and eight patients who received marrow from family members HLA identical for one haplotype but mismatched for one to three loci on the nonshared haplotype. Five patients died of transplant-related complications, and three relapsed at 48, 81, and 1,670 days posttransplant and died of leukemia. Six patients survive in continuous remission from 0.5 to 11.5 years posttransplant.

Second allogeneic marrow transplantation for patients with recurrent leukemia after initial transplant with total-body irradiation-containing regimens.

1993 ◽  
Vol 11 (2) ◽  
pp. 304-313 ◽  
Author(s):  
J P Radich ◽  
J E Sanders ◽  
C D Buckner ◽  
P J Martin ◽  
F B Petersen ◽  
...  
Keyword(s):  
Total Body Irradiation ◽  
Marrow Transplantation ◽  
Acute Gvhd ◽  
High Dose Chemotherapy ◽  
Marrow Transplant ◽  
Myelogenous Leukemia ◽  
High Dose ◽  
Allogeneic Marrow Transplantation ◽  
Total Body ◽  
Allogeneic Marrow

PURPOSE The impact of a second marrow transplant on long-term disease-free survival (DFS) was evaluated for 77 consecutive patients aged 2 to 51 years who relapsed subsequent to allogeneic marrow transplantation after high-dose chemotherapy and total-body irradiation (TBI). PATIENTS AND METHODS Patients received a second transplant for recurrent chronic myelogenous leukemia (CML) (n = 28), acute myelogenous leukemia (AML) (n = 32), and acute lymphoblastic leukemia (ALL) (n = 15) or lymphoma (n = 2) that used the same marrow donor as the initial transplant. High-dose chemotherapy of busulfan (BU) and cyclophosphamide (CY), or CY, carmustine (BCNU), and etoposide (VP-16), was used as a preparative regimen for the second transplant. Graft-versus-host disease (GVHD) prophylaxis consisted of the following: no prophylaxis (n = 8), T-cell depletion (n = 36), methotrexate (MTX) only (n = 21), cyclosporine (CSP) only (n = 1), MTX and CSP (n = 9), or anti-thymocyte globulin (ATG) and prednisone (n = 2). RESULTS Engraftment occurred in the 74 assessable patients. Severe veno-occlusive disease (VOD) was the most frequent cause of grades 3 and 4 regimen-related toxicity (RRT); it occurred in 20 patients. The probability of death before day 100 from nonleukemic causes was 36%. The probability of relapse after second transplant was 70%, and the DFS rate was 14% (median DFS, 36 months; range, 22 to 87). The DFS rates for ALL, AML, and CML were 8%, 10%, and 25%, respectively. Multivariate analysis showed that the risk of relapse was inversely associated with acute GVHD (relative risk [RR] of relapse = 0.2; P = .0009). No other factor was associated with relapse. DFS was associated with the presence of acute GVHD (RR of treatment failure = 0.5; P = .0085), and a reduction of DFS was associated with severe VOD (RR = 10.6; P = .0001) and those patients older than 10 years (RR = 2.5; P = .0337). CONCLUSION These data show that some patients may benefit from a second marrow transplant for recurrent leukemia after an initial marrow transplant. Younger patients and patients with CML especially should be considered as potential candidates for a second transplant.

scholarly journals Fractionated total-body irradiation and high-dose etoposide as a preparatory regimen for bone marrow transplantation for 94 patients with chronic myelogenous leukemia in chronic phase

Blood ◽  
1994 ◽  
Vol 84 (5) ◽  
pp. 1672-1679
Author(s):  
DS Snyder ◽  
RS Negrin ◽  
MR O'Donnell ◽  
NJ Chao ◽  
MD Amylon ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Chronic Myelogenous Leukemia ◽  
Total Body Irradiation ◽  
Marrow Transplantation ◽  
Chronic Phase ◽  
Myelogenous Leukemia ◽  
High Dose ◽  
Allogeneic Bone ◽  
Total Body

Ninety-four consecutive patients with chronic myelogenous leukemia in first clinical chronic phase, median age of 34.0 years (range, 6.8 to 52.4 years), with a histocompatible sibling donor, were treated with fractionated total body irradiation (1,320 cGy) and high-dose etoposide (60 mg/kg) followed by allogeneic bone marrow transplantation (BMT). The median time from diagnosis to BMT was 7.0 months (range, 2.3 to 72.0 months). Sixty patients were treated before BMT with hydroxyurea alone, four patients with busulfan alone, one patient with interferon alone, and the other 29 patients were treated with various combinations of these drugs. Cumulative probabilities of overall survival, event- free survival, and relapse at 5 years were 73%, 64%, and 14%, respectively. The median follow-up time for surviving patients was 38 months, ranging from 12 to 88 months. By stepwise Cox regression analysis, significant prognostic variables were age at transplant, acute graft-versus-host disease > or = grade II, cytomegalovirus- associated interstitial pneumonitis, and years from diagnosis to BMT.

Allogeneic marrow transplantation using fractionated total body irradiation in patients with acute lymphoblastic leukemia in relapse

1982 ◽  
Vol 6 (3) ◽  
pp. 401-407 ◽  
Author(s):  
Reginald A. Clift ◽  
C. Dean Buckner ◽  
E. Donnall Thomas ◽  
Jean E. Sanders ◽  
Patricia S. Stewart ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Total Body Irradiation ◽  
Marrow Transplantation ◽  
Lymphoblastic Leukemia ◽  
Allogeneic Marrow Transplantation ◽  
Total Body ◽  
Allogeneic Marrow

scholarly journals Fractionated total-body irradiation and high-dose etoposide as a preparatory regimen for bone marrow transplantation for 94 patients with chronic myelogenous leukemia in chronic phase

Blood ◽  
1994 ◽  
Vol 84 (5) ◽  
pp. 1672-1679 ◽  
Author(s):  
DS Snyder ◽  
RS Negrin ◽  
MR O'Donnell ◽  
NJ Chao ◽  
MD Amylon ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Chronic Myelogenous Leukemia ◽  
Total Body Irradiation ◽  
Marrow Transplantation ◽  
Chronic Phase ◽  
Myelogenous Leukemia ◽  
High Dose ◽  
Allogeneic Bone ◽  
Total Body

Abstract Ninety-four consecutive patients with chronic myelogenous leukemia in first clinical chronic phase, median age of 34.0 years (range, 6.8 to 52.4 years), with a histocompatible sibling donor, were treated with fractionated total body irradiation (1,320 cGy) and high-dose etoposide (60 mg/kg) followed by allogeneic bone marrow transplantation (BMT). The median time from diagnosis to BMT was 7.0 months (range, 2.3 to 72.0 months). Sixty patients were treated before BMT with hydroxyurea alone, four patients with busulfan alone, one patient with interferon alone, and the other 29 patients were treated with various combinations of these drugs. Cumulative probabilities of overall survival, event- free survival, and relapse at 5 years were 73%, 64%, and 14%, respectively. The median follow-up time for surviving patients was 38 months, ranging from 12 to 88 months. By stepwise Cox regression analysis, significant prognostic variables were age at transplant, acute graft-versus-host disease > or = grade II, cytomegalovirus- associated interstitial pneumonitis, and years from diagnosis to BMT.

Therapy of chronic myelogenous leukemia with allogeneic bone marrow transplantation.

1987 ◽  
Vol 5 (7) ◽  
pp. 1033-1040 ◽  
Author(s):  
P McGlave ◽  
D Arthur ◽  
R Haake ◽  
D Hurd ◽  
W Miller ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Chronic Myelogenous Leukemia ◽  
Total Body Irradiation ◽  
Marrow Transplantation ◽  
Allogeneic Bone Marrow Transplantation ◽  
Chronic Phase ◽  
Myelogenous Leukemia ◽  
Allogeneic Bone ◽  
Total Body

From December 1982 to January 1986, 57 patients received allogeneic bone marrow transplantation as therapy for Philadelphia chromosome (Ph') positive chronic myelogenous leukemia (CML). All patients were prepared for transplantation with cyclophosphamide 60 mg/kg (day -6, -5) and fractionated total body irradiation, 165 cGy twice daily (day -4, -3, -2, -1) and received major histocompatibility (MHC) matched donor marrow (day 0). All patients received graft-v-host disease (GVHD) prophylaxis with methotrexate, prednisone, and either antithymocyte globulin (ATG) (55 patients) or OKT3 infusion (two patients). The projected survival of 29 chronic phase patients is 64% (95% confidence interval [Cl] 42% to 86%); and of 28 accelerated phase patients, 30% (95% Cl, 12% to 48%) at 30 months (P = .005). Multivariate regression analysis of pretransplant patient characteristics demonstrated that the presence of chronic phase and age less than 30 years were the only prognostic features studied that independently predicted survival. No evidence of persistent or recurrent disease has occurred in chronic phase patients; however, reappearance of the Ph' was observed in seven accelerated-phase patients, and hematologic relapse occurred in three of these seven patients. The incidence of grade II to IV acute GVHD is 63% (95% Cl, 50% to 76%) at 100 days, and that of extensive chronic GVHD is 53% (95% Cl, 33% to 74%) at 30 months. The median Karnofsky activity assessment of survivors is 100% (range, 60% to 100%), and all activity assessments less than 100% can be attributed to complications of GVHD. Bone marrow transplantation therapy for CML after preparation with cyclophosphamide and fractionated total body irradiation results in a high proportion of disease-free survival in chronic-phase patients. Survival in accelerated phase is significantly worse and is associated with relapse. GVHD has emerged as a significant cause of morbidity and mortality in this study.

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