Comparison of high doses of total body irradiation in myeloablative conditioning before hematopoietic cell transplantation Journal Article

   


Authors: Sabloff, M.; Chhabra, S.; Wang, T.; Fretham, C.; Kekre, N.; Abraham, A.; Adekola, K.; Auletta, J. J.; Barker, C.; Beitinjaneh, A. M.; Bredeson, C.; Cahn, J. Y.; Diaz, M. A.; Freytes, C.; Gale, R. P.; Ganguly, S.; Gergis, U.; Guinan, E.; Hamilton, B. K.; Hashmi, S.; Hematti, P.; Hildebrandt, G.; Holmberg, L.; Hong, S.; Lazarus, H. M.; Martino, R.; Muffly, L.; Nishihori, T.; Perales, M. A.; Yared, J.; Mineishi, S.; Stadtmauer, E. A.; Pasquini, M. C.; Loren, A. W.
Article Title: Comparison of high doses of total body irradiation in myeloablative conditioning before hematopoietic cell transplantation
Abstract: Malignancy relapse is the most common cause of treatment failure among recipients of hematopoietic cell transplantation (HCT). Conditioning dose intensity can reduce disease relapse but is offset by toxicities. Improvements in radiotherapy techniques and supportive care may translate to better outcomes with higher irradiation doses in the modern era. This study compares outcomes of recipients of increasing doses of high-dose total body irradiation (TBI) divided into intermediate high dose (IH; 13-13.75 Gy) and high dose (HD; 14 Gy) with standard dose (SD; 12 Gy) with cyclophosphamide. A total of 2721 patients ages 18 to 60 years with hematologic malignancies receiving HCT from 2001 to 2013 were included. Cumulative incidences of nonrelapse mortality (NRM) at 5 years were 28% (95% confidence interval [CI], 25% to 30%), 32% (95% CI, 29% to 36%), and 34% (95% CI, 28% to 39%) for SD, IH, and HD, respectively (P =.02). Patients receiving IH-TBI had a 25% higher risk of NRM compared with those receiving SD-TBI (12 Gy) (P =.007). Corresponding cumulative incidences of relapse were 36% (95% CI, 34% to 38%), 32% (95% CI, 29% to 36%), and 26% (95% CI, 21% to 31%; P =.001). Hazard ratios for mortality compared with SD were 1.06 (95% CI,.94 to 1.19; P =.36) for IH and.89 (95% CI,.76 to 1.05; P =.17) for HD. The study demonstrates that despite improvements in supportive care, myeloablative conditioning using higher doses of TBI (with cyclophosphamide) leads to worse NRM and offers no survival benefit over SD, despite reducing disease relapse. © 2019 American Society for Transplantation and Cellular Therapy
Keywords: adult; cancer survival; major clinical study; overall survival; liver dysfunction; disease free survival; radiation dose; methotrexate; outcome assessment; follow up; relapse; cyclophosphamide; hematopoietic stem cell transplantation; chronic myeloid leukemia; cancer mortality; acute lymphoblastic leukemia; acute graft versus host disease; chronic graft versus host disease; myeloablative conditioning; myelodysplastic syndrome; whole body radiation; heart failure; hematologic malignancies; allogeneic hematopoietic stem cell transplantation; observational study; calcineurin inhibitor; graft recipient; multiple organ failure; respiratory failure; allogeneic hematopoietic cell transplantation; acute myeloid leukemia; total body irradiation; mycophenolate mofetil; human; male; female; article
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 25
Issue: 12
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2019-12-01
Start Page: 2398
End Page: 2407
Language: English
DOI: 10.1016/j.bbmt.2019.08.012
PUBMED: 31473319
PROVIDER: scopus
PMCID: PMC7304318
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85072691397&doi=10.1016%2fj.bbmt.2019.08.012&partnerID=40&md5=7addd5e6b1d5041bf44ab206ee3c8996
Notes: Source: Scopus
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MSK Authors
  1. Christopher Barker
    218 Barker
  2. Miguel-Angel Perales
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