Autologous Bone Marrow Transplantation - Blog Science Connections

ABMT in Burkitt's Lymphoma 251
Table 1. Massive Therapy Regimens, With and Without Total Body Irradiation,
Used in Burkitt's Lymphoma
Without total
body irradiation
Chemotherapy Regimen
BACT (Appelbaum)
BACT (Institut Gustave-Roussy)
BEAM
Cyclophosphamide + carmustine
Cyclophosphamide
Cyclophosphamide + doxorubicin +
vinblastine + cytarabine + methotrexate
With total body irradiation
Cyclophosphamide + TBI
BACT + TBI
Cyclophosphamide + vinblastine + TBI
Cyclophosphamide + vinblastine +
doxorubicin + TBI
Cyclophosphamide + doxorubicin + TBI
Investigators
Appelbaum er al. (7)
Philip er a/. (9)
Biron et al. a
Barbasch et al. (17)
Philip (5)
Ekert et al. (18)
Phillips et al. (19)
Philip (5)
Gale et al. (20)
Doueref a/. (21)
Baumgartner er al. (10)
Kaizer er al. (22)
Abbreviations: BACT, carmustine, cytarabine, cyclophosphamide, 6-thioguanine;
BEAM, carmustine, etoposide, cytarabine, melphalan; TBI, total body irradiation.
"See Biron et al., "A Phase II Study of a New Cytoreductive Conditioning Regimen
With Autologous Bone Marrow Transplantation for Lymphomas: The BEAM Protocol,"
in this volume.
introduced in an attempt to reduce the toxicity of the BACT combination (see
Biron et al., "A Phase II Study of a New Cytoreductive Conditioning Regimen
With Autologous Bone Marrow Transplantation for Lymphomas: The BEAM
Protocol," in this volume).
The use of TBI remains somewhat controversial. Its place in conditioning
regimens in leukemia is unquestioned by most, though not all (23), and some
of the massive therapy regimens are undoubtedly not marrow ablative (9).
However, in the case of Burkitt's lymphoma, TBI may not be necessary, and
graft acceptance is not a problem with ABMT. There is little doubt that adding
TBI enhances the toxicity of the procedure, being linked with interstitial
pneumonitis and encephalopathies (24); moreover, in young children the
long-term sequelae must be taken into consideration (25). The question of
localized boostx-ray therapy either pre-or post-ABMT rarely arises in Burkitt's
lymphoma, unlike it can in T-cell lymphoma in which a residual mediastinal
mass may be a problem. In rare cases, however, atypical sites, such as bone,
may be treated in this way. In the case of CNS involvement, it is probably
mandatory to irradiate the cranium at least if TBI is not being used. Relying on