Extramedullary relapse following total marrow and lymphoid irradiation in patients undergoing allogeneic hematopoietic cell transplantation

Autor: Stephen J. Forman, Jeffrey Y.C. Wong, Anthony S. Stein, Timothy E. Schultheiss, Joseph Rosenthal, Nicole Tsai, Joycelynne Palmer, An Liu, Ji Hyun Kim
Rok vydání: 2013
Předmět:
Organs at Risk
Cancer Research
Myeloid
Transplantation Conditioning
medicine.medical_treatment
Graft vs Host Disease
Bone Marrow
Recurrence
Prospective Studies
Prospective cohort study
Child
Lymph node
Melphalan
Etoposide
Radiation
Age Factors
Hematopoietic Stem Cell Transplantation
Radiotherapy Dosage
Total body irradiation
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia
Leukemia
Myeloid
Acute
medicine.anatomical_structure
Oncology
Radiology
Vidarabine
Whole-Body Irradiation
Adult
medicine.medical_specialty
Adolescent
Antineoplastic Agents
Young Adult
medicine
Humans
Radiology
Nuclear Medicine and imaging
Busulfan
Cyclophosphamide
Aged
Lymphatic Irradiation
business.industry
medicine.disease
Surgery
Transplantation
Radiation therapy
Myelodysplastic Syndromes
Bone marrow
business
Blast Crisis
Organ Sparing Treatments
Zdroj: International journal of radiation oncology, biology, physics. 89(1)
ISSN: 1879-355X
Popis: Approximately 5% to 20% of patients who undergo total body irradiation (TBI) in preparation for hematopoietic cell transplantation (HCT) can develop extramedullary (EM) relapse. Whereas total marrow and lymphoid irradiation (TMLI) provides a more conformally targeted radiation therapy for patients, organ sparing has the potential to place the patient at a higher risk for EM relapse than TBI. This study evaluated EM relapse in patients treated with TMLI at our institution.Patients eligible for analysis had been enrolled in 1 of 3 prospective TMLI trials between 2006 and 2012. The TMLI targeted bones, major lymph node chains, liver, spleen, testes, and brain, using image-guided tomotherapy with total dose ranging from 12 to 15 Gy.A total of 101 patients with a median age of 47 years were studied. The median follow-up was 12.8 months. Incidence of EM relapse and bone marrow (BM) relapse were 12.9% and 25.7%, respectively. Of the 13 patients who had EM relapse, 4 also had BM relapse, and 7 had EM disease prior to HCT. There were a total of 19 EM relapse sites as the site of initial recurrence: 11 soft tissue, 6 lymph node, 2 skin. Nine of these sites were within the target region and received ≥12 Gy. Ten initial EM relapse sites were outside of the target region: 5 sites received 10.1 to 11.4 Gy while 5 sites received10 Gy. Pretransplantation EM was the only significant predictor of subsequent EM relapse. The cumulative incidence of EM relapse was 4% at 1 year and 11.4% at 2 years.EM relapse incidence was as frequent in regions receiving ≥10 Gy as those receiving10 Gy. EM relapse rates following TMLI that included HCT regimens were comparable to published results with regimens including TBI and suggest that TMLI is not associated with an increased EM relapse risk.
Databáze: OpenAIRE
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