Comparison of High Doses of Total Body Irradiation in Myeloablative Conditioning before Hematopoietic Cell Transplantation

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 outco...

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Detalles Bibliográficos
Autores: Sabloff, Mitchell, Chhabra, Saurabh|||0000-0001-9117-8696, Wang, Tao|||0000-0002-1323-8697, Fretham, Caitrin, Kekre, Natasha, Abraham, Allistair, Adekola, Kehinde, Auletta, Jeffery J., Barker, Christopher, Beitinjaneh, Amer|||0000-0002-1661-5865, Bredeson, Christopher, Cahn, Jean-Yves, Diaz, Miguel Angel, Freytes, Cesar|||0000-0003-2880-6797, Gale, Robert Peter|||0000-0002-9156-1676, Ganguly, Siddhartha, Gergis, Usama|||0000-0003-0656-7385, Guinan, Eva, Hamilton, Betty K., Hashmi, Shahrukh, Hematti, Peiman|||0000-0001-5836-4497, Hildebrandt, Gerhard|||0000-0003-0478-3340, Holmberg, Leona, Hong, Sanghee|||0000-0001-6383-5994, Lazarus, Hillard M.|||0000-0002-1159-5607, Martino Bofarull, Rodrigo|||0000-0001-5143-4042, Muffly, Lori|||0000-0002-9887-6136, Nishihori, Taiga|||0000-0002-2621-7924, Perales, Miguel-Angel|||0000-0002-5910-4571, Yared, Jean A.., Mineishi, Shin, Stadtmauer, Edward A., Pasquini, Marcelo|||0000-0003-1579-2293, Loren, Alison W.
Tipo de recurso: artículo
Fecha de publicación:2019
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:286427
Acceso en línea:https://ddd.uab.cat/record/286427
https://dx.doi.org/urn:doi:10.1016/j.bbmt.2019.08.012
Access Level:acceso abierto
Palabra clave:Allogeneic hematopoietic cell transplantation
Hematologic malignancies
Myeloablative conditioning
Total body irradiation
Descripción
Sumario: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.

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