Similar survival for patients undergoing reduced-intensity total body irradiation (TBI) versus myeloablative TBI as conditioning for allogeneic transplant in acute leukemia
| Autor: | Zahir Ali, Amelia Langston, Edmund K. Waller, Natia Esiashvili, H. Jean Khoury, Sravanti Rangaraju, J.L. Mikell, William A. Hall, Michael Graiser, Mohammad K. Khan, Jeffrey M. Switchenko |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Transplantation Conditioning medicine.medical_treatment Hematopoietic stem cell transplantation Disease-Free Survival law.invention Myelogenous law Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Karnofsky Performance Status Retrospective Studies Acute leukemia Radiation Leukemia business.industry Age Factors Total body irradiation Length of Stay Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma medicine.disease Allografts Intensive care unit Comorbidity Survival Analysis Surgery Radiation therapy Leukemia Myeloid Acute Oncology Acute Disease Female Neoplasm Recurrence Local business Immunosuppressive Agents Whole-Body Irradiation |
| Zdroj: | International journal of radiation oncology, biology, physics. 89(2) |
| ISSN: | 1879-355X |
| Popis: | 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.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.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).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. |
| Databáze: | OpenAIRE |
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