842 ALLOGENEIC BONE MARROW TRANSPLANTATION IN THE SETTING OF A GENERAL CHILDREN'S HOSPITAL

Abstract

Bone marrow transplantation (BMT) has been performed in specialized centers because of perceived needs for supportive care measures such as laminar flow rooms (LFR), gut sterilization (GS), and leukocyte transfusions (LT). Hospitalizations in such settings are costly. Since June 1979, allogeneic BMT has been performed 11 times in 10 patients (pts) at Texas Children's Hospital: For aplastic anemia (2 pts) (1 pt transplanted twice); acute nonlymphocytic leukemia (4 pts); and acute lymphocytic leukemia (4 pts). All pts were cared for with standard reverse isolation techniques without LFR, GS, or prophylactic LT. Recipients were conditioned with cyclophosphamide; leukemia pts also received total body irradiation (TBI). Identical sibling donor bone marrow was infused 8-12 hours post TBI. All pts required antibiotic treatment for suspected sepsis. Fatal pseudomonas sepsis occurred in 1 pt despite antibiotic therapy and LT. All pts were transfused daily with irradiated platelet concentrates and received methotrexate to prevent graft versus host disease; all achieved marrow engraftment, identified by rising blood counts by 7-20 (mean 13) days post BMT. Eight surviving pts (9 BMT procedures) were discharged 18-30 (mean 24) days post BMT with satisfactory blood counts. These data demonstrate that BMT can be safely performed in a children's hospital without expensive ancillary equipment or procedures.