Clinical Effect of Total Body Irradiation and Hematopoietic Stem Cell Transplantation for Refractory and Relapsed Childhood Leukemia

Objective To explore the efficacy and feasibility of allogeneic hematopoietic stem cell transplantation(allo-HSCT) and total body irradiation(TBI) for refractory and relapsed leukemia.Methods 20 patients with refractory and relapsed leukemia who received allo-HSCT were examined.Bone marrow combined with peripheral blood HSCT was used.All patients were treated with standardized conditioning regimen consisting of cytarabine,busulfan,fludarabine and TBI,etc.Body irradiation used 6MV-X irradiation.Graft-versus-host disease(GVHD) prophylaxis used classic cyclosporin A,methotrexate,anti-thymocyte immunoglobulin and CD25 monoclonal antibody.Complications and disease-free survival after transplantation of patients were observed.Results All of the patients were engrafted and had 100% donor hematological cell after transplantation by cytogenetic evidence analysis.Patients have mild symptoms such as nausea,vomiting,parotid swelling,no case of interstitial pneumonia after TBI.The median follow up time was 12.5 months(6~36 months).8 cases had experience of GVHD,2 died of acute GVHD,2 died of infection and 6 died of relapse.The rest 10 patients were alive in free situation and the disease-free survival rates at 2 years were 50%.Conclusion Hematopoietic stem cell transplantation combined with total body irradiation program is safe and effective treatment for refractory and relapsed leukemia.It can be widely used in clinical as a key technology for salvage therapy.