Faculty Collaboration Database

Similar survival for patients undergoing reduced-intensity total body irradiation (TBI) versus myeloablative TBI as conditioning for allogeneic transplant in acute leukemia. Int J Radiat Oncol Biol Phys 2014 Jun 01;89(2):360-9

Date

05/20/2014

Pubmed ID

24837891

DOI

10.1016/j.ijrobp.2014.02.032

Scopus ID

2-s2.0-84899859754 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

PURPOSE: Hematopoietic stem cell transplantation (HSCT) is the mainstay of treatment for adults with acute leukemia. Total body irradiation (TBI) remains an important part of the conditioning regimen for HCST. For those patients unable to tolerate myeloablative TBI (mTBI), reduced intensity TBI (riTBI) is commonly used. In this study we compared outcomes of patients undergoing mTBI with those of patients undergoing riTBI in our institution.

METHODS AND MATERIALS: We performed a retrospective review of all patients with acute leukemia who underwent TBI-based conditioning, using a prospectively acquired database of HSCT patients treated at our institution. Patient data including details of the transplantation procedure, disease status, Karnofsky performance status (KPS), response rates, toxicity, survival time, and time to progression were extracted. Patient outcomes for various radiation therapy regimens were examined. Descriptive statistical analysis was performed.

RESULTS: Between June 1985 and July 2012, 226 patients with acute leukemia underwent TBI as conditioning for HSCT. Of those patients, 180 had full radiation therapy data available; 83 had acute lymphoblastic leukemia and 94 had acute myelogenous leukemia; 45 patients received riTBI, and 135 received mTBI. Median overall survival (OS) was 13.7 months. Median relapse-free survival (RFS) for all patients was 10.2 months. Controlling for age, sex, KPS, disease status, and diagnosis, there were no significant differences in OS or RFS between patients who underwent riTBI and those who underwent mTBI (P=.402, P=.499, respectively). Median length of hospital stay was shorter for patients who received riTBI than for those who received mTBI (16 days vs 23 days, respectively; P<.001), and intensive care unit admissions were less frequent following riTBI than mTBI (2.22% vs 12.69%, respectively, P=.043). Nonrelapse survival rates were also similar (P=.186).

CONCLUSIONS: No differences in OS or RFS were seen between all patients undergoing riTBI and those undergoing mTBI, despite older age and potential increased comorbidity of riTBI patients. riTBI regimens were associated with shorter length of hospital stay, fewer intensive care unit admissions, and similar rates of nonrelapse survival, which may reflect reduced toxicity. Prospective trials comparing riTBI and mTBI are warranted.

Author List

Mikell JL, Waller EK, Switchenko JM, Rangaraju S, Ali Z, Graiser M, Hall WA, Langston AA, Esiashvili N, Khoury HJ, Khan MK

Author

William Adrian Hall MD Professor in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Age Factors
Allografts
Disease-Free Survival
Female
Humans
Immunosuppressive Agents
Karnofsky Performance Status
Length of Stay
Leukemia
Leukemia, Myeloid, Acute
Male
Middle Aged
Neoplasm Recurrence, Local
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Retrospective Studies
Survival Analysis
Transplantation Conditioning
Whole-Body Irradiation