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J Korean Soc Ther Radiol > Volume 10(2); 1992 > Article
Journal of the Korean Society for Therapeutic Radiology 1992;10(2): 247-254.
Results of Total Body Irradiation in Allogeneic Bone Marrow Transplantation for Acute Non-Lymphocytic Leukermia
Su Mi Chung, Ihl Bohng Choi, In Ah Kim, Sung Hwan Kim, Ki Mun Kang, Kyung Sub Shinn, Choon Cho Kim, Dong Jip Kim
1Department of Therapeutic Radiology, St.Mary's Hospital, Catholic University Medical College, Seoul, Korea.
2Department of Internal Medicine, St.Mary's Hospital, Catholic University Medical College, Seoul, Korea.
Between August 1987 and July 1991, 22 patients with acute nonlymphocytic leukemia have received allogeneic bone Marrow transplantation (BMT) with non-T-Iymphocyte-depleted marrow obtained from matched sibling donors. Of these patients, 12 patients were in first complete remission(CR) and 10 patients in second CR or greater or in relapse. All patients were treated with a preparative regimen consisting of cyclophosphamide (CTX, 60 mg/kg) or combined drags, and 850 cGy single-dose or 150~200 cGy fractionated total body irradiation (TBI) administered twice daily for a total dose of 1200~1320 cGy. Survivors have been followed from 8 to 54.5 months (median, 24 months). The overall 2 year survival rate, relapse rate and incidence of radiation pneumonitis and graft versus host disease(GVHD) have been evaluated by age, phase of disease, initial WBC count, modality of TBI or conditioning chemotherapy. Overall 2 year survival was 58%. The median survival was 31 months and mean survival was 23.2 months. Overall survival have significant impact in patients of age > 19 years old (p=0.008), patients in first CR (p=0.09). Two years survival rate is significantly correlated with age (>19 vs 19, 79.4% vs 14.3%, p=0.0008), regimen of chemotherapy (CTX vs combined drag, 76.9% vs 33.3%, p=0.04), phase of disease (1st CR vs 2nd CR or relapse, 83.3% vs 30%, p=0.01) and method of TBI (fractionated vs single dose, 70.7% vs 37.5%, p=0.05). The influence of French-American-British (FAB) subtypes on relapse rate is not significant, but initial WBC count > 20000/mm3 is associated with increased relapse rate. There is difference in the rate of radiation pneumonitis (14.3% vs 25%1, GVHD (14.3% vs 50%) and relapse (21.4% vs 50%) according to fractionated versus single-dose TBI. As mentioned above, fractionated TBI is compatible for the preparative regimen combined with chemotherapy in allogeneic BMT of first CR patients under 41 years of age with suitable donor. Those results from a retrospective, non-randomized study clearly need additional clinical data, ideally from a randomized study.
Key Words: Acute nonlymphocytic leukemia, Total body irradiation, Bone marrow transplantation
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