Fractionated total body irradiation in allogeneic bone marrow transplantation in leukemia patients: analysis of prognostic factors and results in 136patients

Background and purpose: The results of a single-institution series of patie nts with chronic and acute leukemias are analyzed with regard to literature -reported predictor variables. Materials and methods: Between 1985 and 1994, 136 patients, 82 patients wit h chronic myeloid leukemia (CML) and 54 with acute leukemia (AL), received a uniform preparatory regimen of fractionated total body irradiation (TBI; 12 Gy in 3 days) plus different chemotherapy regimens before bone marrow tr ansplantation. Eighty-six patients were considered to be in early phase of disease (CML in chronic phase or AL in first complete remission) and 50 in advanced phase (all those beyond first remission or first chronic phase). N inety-five patients received unmanipulated allogeneic BM, and 41 T-lymphocy te-depleted BM. Results: The 5-year overall survival (OS) and disease-free survival (DFS) o f the whole series were 43% and 31%, and median survival was 43 and 10 mont hs, respectively. A Cox proportional hazard model identified variables rela ted to overall and disease-free survival. For OS, graft versus host disease (GVHD) was the first independent variable (P < 0.0001), followed by age (P < 0.001), T-depletion (P < 0.01), disease status (P < 0.05) and type of le ukemia (P < 0.05). With regard to DFS, only T-depletion (P < 0.0001), disea se status (P < 0.81) and GVHD (P < 0.01) resulted predictor factors. Early complications after BMT were reported in 59 patients, TBI-induced delayed t oxicity in 9 patients, and 16 patients suffered late complications. Conclusions: Our results confirm the curability of early phase leukemias wi th standard fractionated TBI-induced Allogeneic bone marrow transplantation (ABMT). With an homogeneous fractionated TBI schedule as employed in our s eries, T-cell depletion negatively affected the outcome. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.