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Comparison of High Doses of Total Body Irradiation in Myeloablative Conditioning before Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019 12;25(12):2398-2407

Date

09/02/2019

Pubmed ID

31473319

Pubmed Central ID

PMC7304318

DOI

10.1016/j.bbmt.2019.08.012

Scopus ID

2-s2.0-85072691397   1 Citation

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.

Author List

Sabloff M, Chhabra S, Wang T, Fretham C, Kekre N, Abraham A, Adekola K, Auletta JJ, Barker C, Beitinjaneh AM, Bredeson C, Cahn JY, Diaz MA, Freytes C, Gale RP, Ganguly S, Gergis U, Guinan E, Hamilton BK, Hashmi S, Hematti P, Hildebrandt G, Holmberg L, Hong S, Lazarus HM, Martino R, Muffly L, Nishihori T, Perales MA, Yared J, Mineishi S, Stadtmauer EA, Pasquini MC, Loren AW

Authors

Saurabh Chhabra MD Associate Professor in the Medicine department at Medical College of Wisconsin
Marcelo C. Pasquini MD, MS Professor in the Medicine department at Medical College of Wisconsin
Tao Wang PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin




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

Adolescent
Adult
Allografts
Cyclophosphamide
Disease-Free Survival
Female
Hematologic Neoplasms
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Retrospective Studies
Survival Rate
Transplantation Conditioning
Whole-Body Irradiation
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a