FRACTIONATED TOTAL-BODY IRRADIATION PRECEDING HIGH-DOSE CYTOSINE-ARABINOSIDE AS A PREPARATIVE REGIMEN FOR BONE-MARROW TRANSPLANTATION IN CHILDREN WITH ACUTE-LEUKEMIA

Twenty children with acute leukemia between 3 and 19 years of age unde rwent allogeneic bone marrow transplantation from HLA-matched sibling donors after conditioning with total-body irradiation (1,200 cGy in si x fractions of 200 cGy twice daily for 3 days) and high dose cytosine arabinoside (3 g/m(2) given every 12 hours for 12 doses). Three patien ts died with acute toxicity. Six patients developed grade II acute gra ft versus host disease. With a median follow-up of 68 months (range 26 -96 months), thirteen children (65%) are alive and in remission with K arnofsky scores of 90-100%. A patient with AML in resistant relapse we nt into remission but relapsed and died 5 months post-transplantation. Three other patients relapsed, 8, 12, and 16 months post BMT. Our res ults suggest that this conditioning regimen is associated with high bu t manageable acute toxicity and may be highly effective in controlling leukemia resistant to conventional chemotherapy. (C) 1995 Wiley-Liss. Inc.