Single dose total body irradiation with high dose rate X-ray in combination with cyclophosphamide for bone marrow transplantation in acute nonlymphocytic leukemia initial remission

Abstract

Between November 1976 and December 1980, a total of 18 patients with acute nonlymphocytic leukemia (ANLL) underwent bone marrow transplantation during initial remission. There were ten males and eight females, age ranged between 6 years and 28 years with median age of 14.5 years. These patients were conditioned with high dose cyclophosphamide (60 mg X Kg. I.V.) for two consecutive days followed by total body irradiation with 750 rads, 26 radsl min. to the midplane of the patient by 10 Mv linear accelerator. Individual tissue compensators to head and neck, lung and lower extremity were used for all oatients to imorove dose homoaeneitv. Follow UD time ranqes between 53 months and 3 months with a median-of 13months. Four patients developed acute graft versus host disease (GVHD) and one patient developed chronic GVHD. Two patients developed interstitial pneumonitis. Two oatients relapsed at 24 months and 6.5 months resoectivelv. There was no rejection. Time to engraftment was between I7 days and 43-days with a median of 23 days. Four patients died, one from relapse, two from sepsis and interstitial pneumonitis and one from GVHD and sepsis. Thirteen patients (72%) are surviving free of disease with median follow up time of 13 months. Preliminary results indicate that conditioning with total dose of 750 rads in combination with cyclophosphamide is an acceptable method for bone marrow transplantation in ANLL and provides less discomfort to the patients.