Total body irradiation, fludarabine, melphalan, and allogeneic hematopoietic stem cell transplantation for advanced pediatric hematologic malignancies

D. Petropoulos, L. L. Worth, C. A. Mullen, R. Madden, A. Mahajan, M. Choroszy, Chul S Ha, R. C. Champlin, Kawah W. Chan

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

We evaluated the efficacy and toxicity of adding 9 Gy of total body irradiation (TBI), in three single daily fractions of 3 Gy, to the reduced intensity regimen of fludarabine 30 mg/m2 i.v. × 4 days and melphalan 140 mg/m2 i.v. × 1 day in advanced pediatric hematologic malignancies. Twenty-two acute lymphoblastic leukemia (ALL), six acute myeloid leukemia (AML), and one non-Hodgkin lymphoma patients were transplanted. Of these, 13 were beyond second remission, and five had prior hematopoietic stem cell transplant (HSCT). Twenty-one donors were unrelated, of which 19 were from cord blood (CB) units. Three of the eight related donors were genotypically disparate. Oral mucositis and diarrhea were the most common toxicities. Twenty-seven patients achieved neutrophil engraftment (median 16 days), and 23 had platelet engraftment (median 42 days). One patient had primary graft failure. Seven patients died of non-relapse causes in the first 100 days. With a median follow-up of 52 months, seven of 22 ALL, five of six AML, and one of one lymphoma patients are alive and in remission. The regimen of TBI, fludarabine, and melphalan allows the engraftment of allogeneic hematopoietic stem cells (including mismatched CB). It was fairly well tolerated in pediatric patients, even for second transplants. Its efficacy requires further evaluation.

Original languageEnglish (US)
Pages (from-to)463-467
Number of pages5
JournalBone Marrow Transplantation
Volume37
Issue number5
DOIs
StatePublished - Mar 2006
Externally publishedYes

Fingerprint

Melphalan
Whole-Body Irradiation
Hematopoietic Stem Cell Transplantation
Hematologic Neoplasms
Pediatrics
Hematopoietic Stem Cells
Transplants
Fetal Blood
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Unrelated Donors
Stomatitis
Non-Hodgkin's Lymphoma
fludarabine
Diarrhea
Lymphoma
Neutrophils
Blood Platelets
Tissue Donors

Keywords

  • Fludarabine
  • Melphalan
  • Pediatric leukemia
  • Total body irradiation
  • Umbilical cord blood transplants

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Total body irradiation, fludarabine, melphalan, and allogeneic hematopoietic stem cell transplantation for advanced pediatric hematologic malignancies. / Petropoulos, D.; Worth, L. L.; Mullen, C. A.; Madden, R.; Mahajan, A.; Choroszy, M.; Ha, Chul S; Champlin, R. C.; Chan, Kawah W.

In: Bone Marrow Transplantation, Vol. 37, No. 5, 03.2006, p. 463-467.

Research output: Contribution to journalArticle

Petropoulos, D. ; Worth, L. L. ; Mullen, C. A. ; Madden, R. ; Mahajan, A. ; Choroszy, M. ; Ha, Chul S ; Champlin, R. C. ; Chan, Kawah W. / Total body irradiation, fludarabine, melphalan, and allogeneic hematopoietic stem cell transplantation for advanced pediatric hematologic malignancies. In: Bone Marrow Transplantation. 2006 ; Vol. 37, No. 5. pp. 463-467.
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