Bone-Marrow Ablation and Allogeneic Marrow Transplantation in Acute Leukemia

Abstract

Thirty-three patients with acute leukemia (15 with lymphoblastic leukemia and 18 with myeloblastic leukemia) were entered into a program of high-dose radiochemotherapy followed by allogeneic bone-marrow transplantation. These patients were in various clinical stages of disease. Of 10 in complete hematologic remission at the time of transplantation, seven were alive without maintenance therapy at the time of evaluation, eight to 35 months after grafting; one was in relapse. Of 11 who received transplants during partial remission, six were in remission without further treatment eight to 33 months after transplantation. In 12 the disease was refractory to chemotherapy when preparation for transplantation was started, and only one of them was alive and free of disease after 10 months. Recurrent leukemia, graft-versus-host disease, viral pneumonia, and early therapy-related toxicity were the major causes of failure. High-dose chemotherapy and total-body irradiation followed by allogeneic marrow transplantation performed during complete or partial remission can produce long-term remission of acute leukemia.

Diretrizes para o diagnóstico, classificação, profilaxia e tratamento da doença enxerto contra hospedeiro crônica

“…Ainda que regimes de condicionamento de intensidade reduzida tenham sido associados a uma menor incidência de DECH-a, o mesmo não ocorreu com a doença crônica. 14 Blume e cols 14 utilizaram no início da década de 80 um esquema de uso de corticosteroide estendido além da fase aguda pós-transplante. Foi observada menor incidência de DECH-c, porém sem confirmação em outros estudos (EIa).…”

Comparing i.v. BU dose intensity between two regimens (FB2 vs FB4) for allogeneic HCT for AML in CR1: a report from the Acute Leukemia Working Party of EBMT

“…[1][2][3][4][5][6][7] Traditionally, allogeneic HCT was performed using myeloablative conditioning regimens that incorporated high doses of TBI plus chemotherapy or a combination of BU and CY, among other options. 1,2,8,9 The resulting toxicity and consequent morbidity and mortality from the procedure, which exceeded 30% in most cases, limited the applicability of allo-HCT to patients of more advanced age or with a suboptimal performance status or a high HCT comorbidity index.…”

“…[1][2][3][4][5][6][7] Traditionally, allogeneic HCT was performed using myeloablative conditioning regimens that incorporated high doses of TBI plus chemotherapy or a combination of BU and CY, among other options. 1,2,8,9 The resulting toxicity and consequent morbidity and mortality from the procedure, which exceeded 30% in most cases, limited the applicability of allo-HCT to patients of more advanced age or with a suboptimal performance status or a high HCT comorbidity index. [10][11][12] While the therapeutic benefits of allo-HCT are probably derived from both the myeloablative cytotoxicity of the regimen prior to transplantation as well as the immunological graft-versusleukemia effect of donor cells against host leukemic cells, a better understanding of the bona fide immunological benefits associated with the latter paved the way for the development of newer regimens, so called reduced-intensity (or reduced-toxicity) conditioning (RIC) regimens.…”

Common genomic HLA haplotypes contributing to successful donor search in unrelated hematopoietic transplantation

“…[1][2][3] For patients lacking a genotypically HLA-matched sibling, an unrelated HSC transplantation can be proposed. [4][5][6] Historically, unrelated HSC transplantations were performed with donor/recipient pairs that were serologically identical for HLA-A, B, and DR antigens.…”