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

R. E. Duerst, J. T. Horan, J. L. Liesveld, C. N. Abboud, L. M. Zwetsch, E. S. Senf, L. S. Constine, R. F. Raubertas, J. A. Passarell, J. F. DiPersio

Research output: Contribution to journalArticle

18 Scopus citations

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 x 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.

Original languageEnglish
Pages (from-to)489-494
Number of pages6
JournalBone Marrow Transplantation
Volume25
Issue number5
DOIs
StatePublished - Jan 1 2000

Keywords

  • Allogeneic marrow transplantation
  • Children
  • Cyclophosphamide
  • Etoposide
  • Total body irradiation

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