INTENSIVE CONDITIONING REGIMEN FOR BONE-MARROW TRANSPLANTATION IN CHILDREN WITH HIGH-RISK HEMATOLOGICAL MALIGNANCIES

Between September 1987 and May 1991, 21 children aged 10 months to 15 years (median 9 years) underwent bone marrow transplantation (BMT) for advanced haematological malignancies using a conditioning regimen con sisting of total body irradiation (TBI), etoposide 1.8 g/m2 by continu ous infusion, and cyclophosphamide 2 g/m2 on 3 consecutive days. The p atients included 14 with acute lymphoblastic leukaemia (ALL), 1 with c hronic myeloid leukaemia (CML), 1 with juvenile CML, 4 with non-Hodgki n's lymphoma and 1 with acute nonlymphocytic leukaemia. Eleven had an allogenic BMT from an HLA-matched sibling, and 1 from an unrelated don or. Nine patients received 4-hydroperoxycyclophosphamide purged autolo gous marrow. Median time to myeloid engraftment (ANC > 500/mul) was 19 days in allogeneic BMT patients and 28 days in autologous BMT patient s (P < .01). Mucositis was the major regimen-related toxicity (RRT). G I toxicity in the form of diarrhoea affected ten patients and five had veno-occlusive disease of the liver. Two patients had mild bladder to xicity and one died of renal toxicity. There was no CNS or cardiac tox icity. There was no significant difference in the incidence of toxicit y according to the type of BMT (autologous or allogeneic), total dose, or sequence of TBI. With a median follow-up of 44 months, ten patient s are alive (6/12 allogeneic BMT patients and 4/9 autologous BMT patie nts). Of the 11 deaths, four were related to toxicity (2 aspergillus, 1 haemorrhage following liver biopsy, and 1 from haemolytic-uraemic sy ndrome), and 4/12 allogeneic and 4/9 autologous BMT patients died from relapsed disease. This conditioning regimen is well tolerated in chil dren, demonstrating mild and reversible RRT. (C) 1994 Wiley-Liss, Inc.