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This is the first report of doxorubicin (Adriamycin) interacting with whole-body electro-beam irradiation to produce generalized toxic epidermal necrolysis. The patient was a 32-year-old woman with acute myelomonocytic leukemia and leukemia cutis. The severe dermatitis obscured clinical recognition of concomitant pseudomembranous colitis and contributed to the patient's death during management of toxic megacolon. Suggestions are made for minimizing this occurrence in future patients treated in a similar fashion.

Of the first 14 patients with acute or chronic leukemia to undergo bone marrow transplantation at our hospital, 9 (64%), all good-risk, are still alive in remission at 18 to 42 months of follow-up (mean, 29 months) with their Karnofsky performance status between 80% and 100%. The conditioning regimen of fractionated-dose irradiation and high-dose chemotherapy eradicated their disease; only two patients relapsed after transplantation. Toxicity was acceptable. Acute graft-versus-host disease developed in six patients (43%) (grade I or II in four, grade IV in two) and progressed to chronic graft-versus-host disease in four. Viral pneumonitis developed in three patients (21%), but none had idiopathic interstitial pneumonitis. The mean hospital charge was $54,355. These preliminary results suggest that good-risk patients with acute or chronic leukemia can be treated with bone marrow transplantation in a university affiliated hospital with appropriate staff and support facilities and achieve results comparable to those in research institutions at a competitive cost.