Allogeneic bone marrow (BM) peripheral blood progenitor cells (PBPC) transplantations in two cases prepared with the use of total body irradiation (TBI)

Abstract

The main aims for preparative regimens in BMT/PBPCT are malignant cell eradication and/or immunosupresion to facilitate engraftment. TBI is used in concert with cyclophospamide (Cy) to increase activity.

In our Unit two TBI + Cy conditioned allotransplantations – (1) BMT and (2) PBPCT – have been performed. Patients – (1) 7 years and (2) 10 years old, males, suffering from: (1) ALL – second and (2) ALL – fourth remission, received transplant material from HLA identical siblings. Transplant preparative regimens consisted of TBI (Co-60 + electrons 6 and 9 MeV: 12–16 Gy. performed in Greatpoland Cancer Centre, Poznań) and Cy (200 mg/kg bw). Patients received routine decontamination for infection prevention. Heparine for VOD and Cyclosporine + MTX for GvHD prophylaxis. Treatment related toxicity was judged accordind to WHO scale, standard criteria were used for GvHD grading.

Both patients were Hepatitis B virus positive, patient (2) was also HCV + before treatment. Hematological recovery was observed in both patient (1) 13 and (2) 10 days after transplantation. Toxicity in patient (1) was WHO-1 for the liver and WHO-1 for kidneys. There was no skin or mucosal toxicity. Patient (2) had WHO-2 GIT mucosa and WHO-3 liver toxicities on day +15. No skin toxicity was observed. On day +16 patient(2) rapidly developed signs of pulmonary complications further followed by CNS involvement. He required artificial ventilation. No aGvHD observed. Patient died on day +31. Patient (1) is alive and well +36 days after transplantation. aGvHD grade I (skin) was observed on day +25 after transplantation and responded well to glukokorticosteroid therapy (2mg/kg for 5 days).

The post-transplant history of these two cases reflects on possible complications of BMT/PBPCT with TBI.