Allogeneic Bone Marrow Transplantation Using Total Body Irradiation/Busulfan/ Melphalan as Conditioning for Pediatric Patients with Refractory Leukemia

Abstract

We report the therapeutic results of allogeneic bone marrow transplantations (BMTs) for 4 pediatric patients with refractory leukemia. The conditioning regimen consisted of total body irradiation (TBI), busulfan (Bu) and melphalan (L-PAM). Three recipients received marrow cells from HLA fully matched related donors and one from one locus-mismatched unrelated donor. All 4 cases were given methotrexate and cyclosporinA for graft-versus-host disease (GVHD) prophylaxis. Three of the 4 cases developed gradeIII to IV acute GVHD, 2 of which required FK-506 for disease control. In 2 evaluable cases, chronic GVHD was not noted. Although all cases suffered from severe mucositis mainly due to the adverse effects of L-PAM, none had mortal regimen-related-toxicity. After BMT, no leukemic relapse occurred, and 2 of the cases have continued complete remission for 24 months and 14 months. Two patients died from complications, one on day + 120, from acute renal failure caused by rhabdomyolysis, and the other on day + 56, from cytomegalovirus pneumonitis. These results suggest that the combination of TBI, Bu and L-PAM as a BMT regimen could be effective for pediatric patients with refractory leukemia.