Comparison of High Doses of Total Body Irradiation in Myeloablative Conditioning before Hematopoietic Cell Transplantation
Sabloff, Mitchell (University of Ottawa and Ottawa Hospital Research Institute)
Chhabra, Saurabh (Medical College of Wisconsin)
Wang, Tao (Medical College of Wisconsin)
Fretham, Caitrin (National Marrow Donor Program/Be the Match)
Kekre, Natasha (The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute)
Abraham, Allistair (Children's National Medical Center)
Adekola, Kehinde (Northwestern University)
Auletta, Jeffery J. (Nationwide Children's Hospital)
Barker, Christopher (Memorial Sloan Kettering Cancer Center)
Beitinjaneh, Amer (University of Miami)
Bredeson, Christopher (The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute)
Cahn, Jean-Yves (CHU Grenoble Alpes)
Diaz, Miguel Angel (Hospital Infantil Universitario Niño Jesus)
Freytes, Cesar (Texas Transplant Institute)
Gale, Robert Peter (Imperial College London)
Ganguly, Siddhartha (University of Kansas Health System)
Gergis, Usama (New York Presbyterian Hospital/Weill Cornell Medical Center)
Guinan, Eva (Dana-Farber Cancer Institute (Boston, Estats Units d'Amèrica))
Hamilton, Betty K. (Cleveland Clinic Taussig Cancer Institute)
Hashmi, Shahrukh (King Faisal Specialist Hospital and Research Centre (Aràbia Saudita))
Hematti, Peiman (University of Wisconsin)
Hildebrandt, Gerhard (University of Kentucky)
Holmberg, Leona (Fred Hutchinson Cancer Research Center)
Hong, Sanghee (Cleveland Clinic Taussig Cancer Center)
Lazarus, Hillard M. (Case Western Reserve University)
Martino Bofarull, Rodrigo (Institut d'Investigació Biomèdica Sant Pau)
Muffly, Lori (Stanford University)
Nishihori, Taiga (H. Lee Moffitt Cancer Center and Research Institute)
Perales, Miguel-Angel (Memorial Sloan Kettering Cancer Center)
Yared, Jean (University of Maryland)
Mineishi, Shin (Penn State Hershey Medical Center)
Stadtmauer, Edward A. (University of Pennsylvania Medical Center)
Pasquini, Marcelo (Medical College of Wisconsin)
Loren, Alison W. (Perelman School of Medicine at the University of Pennsylvania)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Allogeneic hematopoietic cell transplantation ; Hematologic malignancies ; Myeloablative conditioning ; Total body irradiation
Publicat a:	Biology of blood and marrow transplantation, Vol. 25 Núm. 12 (december 2019) , p. 2398-2407, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2019.08.012
PMID: 31473319

10 p, 971.5 KB

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