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Conditioning Regimens

Allogeneic bone marrow transplantation for children with acute leukemia: cytoreduction with fractionated total body irradiation, high-dose etoposide and cyclophosphamide

Bone Marrow Transplantation volume 25, pages 489–494 (2000)Cite this article

Abstract

Marrow-ablative chemo-radiotherapy followed by hematopoietic stem cell rescue from an allogeneic source improves outcomes for children with high-risk acute leukemia. The first effective pre-transplant preparative regimens consisted of high-dose cyclophosphamide (CY) and total body irradiation (TBI). Subsequent attempts have been made to improve leukemia-free survival, by adding other chemotherapy agents to these agents. In previous clinical studies of total body irradiation, etoposide, cyclophosphamide (TBI-VP-16-Cy) in adult allogeneic bone marrow transplantation, there has been a high incidence of severe regimen-related toxicity. In this study, we investigated the safety and efficacy of this combination in 41 children who received TBI (12–14 Gy), VP-16 (30 mg/kg), and CY (60 mg/kg × 2) and then either matched sibling or alternative donor transplants for acute leukemia. There was only one case of fatal regimen-related toxicity. The estimated 3-year event-free survival for patients with early or intermediate stage disease was 68% (53–88%). The estimated event-free survival of patients with advanced disease was 17% (5–59%). TBI-VP16-CY is safe in pediatric transplantation, and it has good efficacy for transplant recipients with less advanced disease. Bone Marrow Transplantation (2000) 25, 489–494.

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Author notes

  1. JF DiPersio

    Present address: Division of Stem Cell Transplantation, Washington University, St Louis, MO 63110, USA

  2. RE Duerst and JT Horan: The first two authors contributed equally to this work

Authors and Affiliations

  1. Department of Pediatrics, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA

    RE Duerst, JT Horan & LM Zwetsch

  2. Department of Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA

    JL Liesveld, CN Abboud, ES Senf & JF DiPersio

  3. Department of Radiation Oncology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA

    LS Constine

  4. Department of Biostatistics, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA

    RF Raubertas & JA Passarell

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Duerst, R., Horan, J., Liesveld, J. et al. Allogeneic bone marrow transplantation for children with acute leukemia: cytoreduction with fractionated total body irradiation, high-dose etoposide and cyclophosphamide. Bone Marrow Transplant 25, 489–494 (2000). https://doi.org/10.1038/sj.bmt.1702181

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  • DOI: https://doi.org/10.1038/sj.bmt.1702181

Keywords

  • allogeneic marrow transplantation
  • etoposide
  • cyclophosphamide
  • total body irradiation
  • children

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