Clinical outcome

Clinical trials have shown better survival after high-dose therapy with appropriate rescue than after conventional chemotherapy for selected patients with acute myeloid and acute lymphatic leukaemia. Some benefit has been shown for patients with high-risk node-positive breast cancer, stage IV neuroblastoma, and high-grade lymphoma, but the role of high-dose therapy in these settings needs further clarification.

Comparisons of chemotherapy with and without TBI for conditioning are not conclusive. TBI is preferred where more immune suppression is needed (e.g. mismatched grafts). Chemotherapy is preferred for benign disease because of the increased risk of second tumour induction with TBI. Otherwise, choices are based on the differing patterns of toxicity of the modalities of conditioning.

TBI may be considered for more frequent use in adults where growth and developmental problems are less important.

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