BONE-MARROW TRANSPLANTATION FOR PHILADELPHIA-CHROMOSOME-POSITIVE ACUTE LYMPHOBLASTIC-LEUKEMIA

The outcome of 14 bone marrow transplants (BMT) tautologous 4; allogen eic 10) for Philadelphia-chrome some (Ph(1)) positive acute lymphoblas tic leukemia (ALL) was analyzed. Preparative regimens consisted of eto poside (VP16) (30 or 45 mg/kg BW) (n = 14), cyclophosphamide (CY)(120 mg/kg BW) (n = 14), and total body irradiation (TBI)(12 Gy) (n = 13) o r busulfan (Bu)(16 mg/kg) (n = 1). an patients receiving autologous ma rrow were in complete remission (CR) (three patients in 1.CR, one pati ent in 2.CR) at the time of BMT. For allogeneic BMT (nine related, one unrelated donor), seven patients were in first CR, two patients in fi rst refractory relapse, and one patient in second relapse. With a medi an follow-up of 503 days (range 93-1522 days), eight out of 14 patient s are alive in remission (six out of 10 patients receiving allogeneic, and two out of four patients receiving autologous BMT). Disease-free survival for all patients is 46%. Causes of death were relapse (n = 3) and transplant-related toxicity (n = 3). All patients tested for the bcr/abl rearrangement by reverse transcriptase-polymerase chain reacti on (RT-PCR) were negative 4 weeks post-BMT. Two of the three patients who subsequently relapsed were repeatedly RT-PCR positive prior to rel apse (test not done in the third). Considering the negligible cure rat e of Phl-positive ALL with conventional chemotherapy regimens, our dat a support the concept of early (greater than or equal to CR) BMT (allo geneic > autologous (purged)) following triple therapy with TBI, VP16, and CY.