Autologous Bone Marrow Transplantation - Blog Science Connections

602 Total Body Irradiation, Cytarabine, and Melphalan
PATIENTS AND METHODS
Twenty-four patients (these included 19 children and 5 young adults, from
15 to 28 years old; median age was 10.5 years [range, 4-28 years]) underwent
bone marrow transplantation, using a preparative regimen consisting of
fractionated TBI (12 Gy, 6 fractions in 3 days) from day -11 to day -9 followed
by 8 doses of HD ara-C, 3 g/m 2 intravenously over 3 hours every 12 hours for 8
doses (day -7 to day -4). Melphalan was administered over half an hour (140
mg/m 2 ) under hyperhydration on day -2 (RALL 86 protocol).
Bone marrow was infused intravenously on day 0 (Table 1 ). All patients
were isolated in a protective environment and all blood products were irradiated
with 45 Gy.
Among ALL patients, 12 were treated in CR2 after early relapse on therapy,
4 in CR3 or later, and 4 during relapse.
One adult patient was treated for acute myeloblastic leukemia (AML) j n
second relapse, and three patients were treated for chronic myeloid leukemia
(CML; one chronic, one accelerated, one acute).
Eight patients received an autologous bone marrow transplantation
(ABMT) after in vitro treatment of the marrow with chemotherapy or monoclonal
antibodies and complement. Mine patients received an HLA-identical allogeneic
bone marrow transplantation (BMT) unmanipulated in seven of nine cases,
using methotrexate for graft-versus-host disease prophylaxis until the thirtieth
day, and in two cases marrow depleted of T cells (CD 2, 5, 7 and C) (9). Seven
patients (three with chronic, four with acute leukemia) received transplants
from familial nonidentical donors using T-cell depletion of the graft and
additional immunosuppression with rabbit antithymocyte globulins (Institut
Merieux, France) (manuscript in preparation). Twenty-one of the 24 patients
had previously been heavily pretreated.
Table 1. RALL 86 Conditioning Regimen
Regimen Days -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0
TBI
12 Gy, 6
fractions x x x
HD ara-C
3 g/m 2 q12hr x x x x
Melphalan
140 mg/m 2 x
Transplantation
x