Fractionated total body irradiation and high-dose VP 16-213 followed by
allogeneic bone marrow transplantation in advanced leukemias
N Schmitz, W Gassmann, M Rister, W Johannson, M Suttorp, F Brix, JJ Holthuis, W Heit, B Hertenstein and J Schaub
Department of Internal Medicine II, University of Kiel, FRG.
Thirty-eight patients (median age, 21 years) with acute nonlymphoblastic
leukemia (ANLL) (17 patients), acute lymphoblastic leukemia/lymphoma (ALL)
(18 patients), chronic myelogenous leukemia (two patients), and refractory
anemia received allogeneic bone marrow transplants from HLA-identical
sibling donors or a one-antigen- mismatched brother (one patient) after a
preparatory regimen consisting of fractionated total body irradiation and
high-dose VP 16-213 (60 to 70 mg/kg body weight). Of the 33 patients with
acute leukemia who received grafts from HLA-identical donors, three
patients with ANLL received transplants in first remission and one patient
with standard- risk ALL received a graft while in second remission. All
other patients were in more advanced stages of their disease or exhibited
other high- risk features. At the time of analysis, 20 of the 33 patients
were alive, with 19 of them remaining in continued complete remission for 6
to 35 months (median, 18 months). The 3-year actuarial disease-free
survival rate of 56.6% +/- 9.7% (SE) and the actuarial relapse rate of
11.9% +/- 6.8% (SE) demonstrate that the combination of fractionated total
body irradiation and high-dose VP 16 is an effective mode of therapy in
patients with advanced leukemias. Preliminary experience cautions against
the use of VP 16 instead of cyclophosphamide in any clinical situation
carrying an increased risk of graft rejection because the immunosuppressive
potency of VP 16 is largely untested but may be inferior to that of
cyclophosphamide.
Volume 72,
Issue 5,
pp. 1567-1573,
11/01/1988
Copyright © 1988 by The American Society of Hematology
