Autologous Bone Marrow Transplantation - Blog Science Connections

Total Body Irradiation, Cytarabine, and Melphalan 603
RESULTS
The Regimen's Toxicity
Since all 24 patients completed the preparative RALL 86 regimen, its
toxicity was évaluable according to Herzig's score in all of them. The patients'
toxic reactions were: reactions of the eye—10 patients, 41.7%, no severe toxicity;
gastrointestinal— 11 patients, 45.8%, 4 severe; CNS—4 patients, 16.7%, 3 severe
including 1 lethal; skin—10 patients, 41.7%, with dry desquamation; liver—9
patients, 33.3%, 3 severe including 1 lethal; documented infections—9 patients,
37.5%, 2 lethal.
Among noninfectious toxic reactions, two were lethal in two children with
ALL in CR2 ( 1 allogeneic BMT and 1ABMT): lethal encephalopathy occurred a
few days after transplantation in a child who had received radiotherapy (18 Gy)
to the CNS 3 weeks before transplantation, and the second child died of
veno-occlusive disease of the liver 35 days after transplantation. Two infectionrelated
toxic reactions were lethal, one in a patient who developed pseudomonas
cellulitis the day before transplantation, and the other in a patient who died of
cytomegalovirus pneumonitis 72 days after transplantation. Both infectionrelated
deaths occurred in patients who had received mismatched marrow.
The global mortality of patients in the pilot study was 16.6%. Engraftment
was stable in all 22 évaluable patients, especially in the mismatched group who
had no severe graft-versus-host disease, graft rejection, or failure.
Antileukemic Response
Seven patients (4 with ALL, 1 AML, and 2 CML) whose antileukemic
response was évaluable obtained complete remissions. We need a longer
follow-up to evaluate the duration of response in this group, as well as in the
other patients in remission.
DISCUSSION
Different approaches to improve antileukemic treatments are being
investigated as pretransplantation regimens in high-risk patients who have
relapsed. The combined use of fractioned TBI, HD ara-C, and HDM has an
acceptable toxicity in young patients. Only one death occurred in the ABMT
group. The regimen's antileukemic activity needs to be confirmed in a larger
series of patients and with a longer follow-up. Because of the encouraging
results of this study, we are now evaluating the feasibility of using this protocol
with lower doses of ara-C (12 g/m 2 ) in older patients.
REFERENCES
1. Cahn JY, Hervé P, Flesch M, Plouvier E, Noir A, Racadot E, Montcuquet P, Behar C, Pignon B,
Boilletot A, Lutz P, Henon P, Rozenbaum A, Peters A, Leconte des Fions R. Br J Haematol
1986*3:457.