INFLUENCE OF FRACTIONATED TOTAL-BODY IRRADIATION ON MUCOSAL TOXICITY IN INTENSIFIED CONDITIONING REGIMENS FOR AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN PEDIATRIC CANCER-PATIENTS

From April 1988 to March 1991 28 children with generalized solid tumor s (N = 15) or hematologic malignancies (N = 13) received intensified m yelotoxic regimens followed by autologous stem cell rescue (ABMT). The se intensified regimens consisted of 12 Gy fractionated total body irr adiation (FTBI) and 2 (or 3) cytotoxic drugs (group A, n = 19) or a co mbination of 3 cytotoxic drugs (group B, n = 9). FTBI-containing regim ens produced more severe mucositis > = WHO grade 3 (p = 0.01) and a lo nger duration of severe mucositis. The mucositis had a median duration of 8 days (range 0-28) in group A compared with median 0 days (range 0-7) in group B (p < 0.01). Acute renal and liver toxicity were not di fferent. The probability of overall survival at day + 100 was 89% in a ll patients. In terms of long-term survival FTBI containing regimen di d not prove superior: 5 out of 19 patients in group A and 6 out of 9 p atients in group B have been survivors for a minimum of 3 years. In co nclusion, severe gastrointestinal toxicity of such intensive regimens is avoidable if FTBI is omitted.