Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Effects of total body irradiation-based conditioning on allogeneic stem cell transplantation for pediatric acute leukemia: a single-institution study

  • Park, Jongmoo (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Eun Kyung (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong Hoon (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Wook (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Si Yeol (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Sang Min (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young Seok (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Su Ssan (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Jin-Hong (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Jaehyeon (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Seung Do (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.05.07
  • Accepted : 2014.09.01
  • Published : 2014.09.30
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Abstract

Purpose: To evaluate the effects of total body irradiation (TBI), as a conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT), in pediatric acute leukemia patients. Materials and Methods: From January 2001 to December 2011, 28 patients, aged less than 18 years, were treated with TBI-based conditioning for allo-SCT in our institution. Of the 28 patients, 21 patients were diagnosed with acute lymphoblastic leukemia (ALL, 75%) and 7 were diagnosed with acute myeloid leukemia (AML, 25%). TBI was completed 4 days or 1 day before stem cell infusion. Patients underwent radiation therapy with bilateral parallel opposing fields and 6-MV X-rays. The Kaplan-Meier method was used to calculate survival outcomes. Results: The 2-year event-free survival and overall survival rates were 66% and 56%, respectively (71.4% and 60.0% in AML patients vs. 64.3% and 52.4% in ALL patients, respectively). Treatment related mortality rate were 25%. Acute and chronic graft-versus-host disease was a major complication; other complications included endocrine dysfunction and pulmonary complications. Common complications from TBI were nausea (89%) and cataracts (7.1%). Conclusion: The efficacy and toxicity data in this study of TBI-based conditioning to pediatric acute leukemia patients were comparable with previous studies. However, clinicians need to focus on the acute and chronic complications related to allo-SCT.

Keywords

References

  1. Pulte D, Gondos A, Brenner H. Trends in 5- and 10-year survival after diagnosis with childhood hematologic malignancies in the United States, 1990-2004. J Natl Cancer Inst 2008;100:1301-9. https://doi.org/10.1093/jnci/djn276
  2. Creutzig U, Zimmermann M, Ritter J, et al. Treatment strategies and long-term results in paediatric patients treated in four consecutive AML-BFM trials. Leukemia 2005;19:2030-42. https://doi.org/10.1038/sj.leu.2403920
  3. Lange BJ, Smith FO, Feusner J, et al. Outcomes in CCG-2961, a children's oncology group phase 3 trial for untreated pediatric acute myeloid leukemia: a report from the children's oncology group. Blood 2008;111:1044-53.
  4. Rovelli A, Arrigo C, Nesi F, et al. The role of thalidomide in the treatment of refractory chronic graft-versus-host disease following bone marrow transplantation in children. Bone Marrow Transplant 1998;21:577-81. https://doi.org/10.1038/sj.bmt.1701138
  5. Wachowiak J, Malicki J, Buczkowski D, et al. Allogeneic bone marrow transplantation in children with acute lymphoblastic leukaemia in the first and second complete remission conditioned with fractionated total body irradiation and cyclophosphamide or etoposide. Rep Pract Oncol Radiother, 2002;7:117-25. https://doi.org/10.1016/S1507-1367(02)70986-3
  6. Sorror ML, Maris MB, Storb R, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005;106:2912-9. https://doi.org/10.1182/blood-2005-05-2004
  7. Sorror ML, Storer BE, Maloney DG, Sandmaier BM, Martin PJ, Storb R. Outcomes after allogeneic hematopoietic cell transplantation with nonmyeloablative or myeloablative conditioning regimens for treatment of lymphoma and chronic lymphocytic leukemia. Blood 2008;111:446-52. https://doi.org/10.1182/blood-2007-07-098483
  8. Scott BL, Sandmaier BM, Storer B, et al. Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis. Leukemia 2006;20:128-35. https://doi.org/10.1038/sj.leu.2404010
  9. Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versus-host disease. Lancet 2009;373:1550-61. https://doi.org/10.1016/S0140-6736(09)60237-3
  10. Przepiorka D, Weisdorf D, Martin P, et al. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant 1995;15:825-8.
  11. Thomas E, Storb R, Clift RA, et al. Bone-marrow transplantation (first of two parts). N Engl J Med 1975;292:832-43. https://doi.org/10.1056/NEJM197504172921605
  12. Thomas ED, Storb R, Clift RA, et al. Bone-marrow transplantation (second of two parts). N Engl J Med 1975;292:895-902. https://doi.org/10.1056/NEJM197504242921706
  13. Shulman HM, Sullivan KM, Weiden PL, et al. Chronic graftversus- host syndrome in man: a long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980;69:204-17. https://doi.org/10.1016/0002-9343(80)90380-0
  14. Fefer A, Einstein AB, Thomas ED, et al. Bone-marrow transplantation for hematologic neoplasia in 16 patients with identical twins. N Engl J Med 1974;290:1389-93. https://doi.org/10.1056/NEJM197406202902501
  15. Shi-Xia X, Xian-Hua T, Hai-Qin X, Bo F, Xiang-Feng T. Total body irradiation plus cyclophosphamide versus busulphan with cyclophosphamide as conditioning regimen for patients with leukemia undergoing allogeneic stem cell transplantation: a meta-analysis. Leuk Lymphoma 2010;51:50-60. https://doi.org/10.3109/10428190903419130
  16. Hartman AR, Williams SF, Dillon JJ. Survival, diseasefree survival and adverse effects of conditioning for allogeneic bone marrow transplantation with busulfan/cyclophosphamide vs total body irradiation: a meta-analysis. Bone Marrow Transplant 1998;22:439-43. https://doi.org/10.1038/sj.bmt.1701334
  17. Litzow MR, Perez WS, Klein JP, et al. Comparison of outcome following allogeneic bone marrow transplantation with cyclophosphamide-total body irradiation versus busulphancyclophosphamide conditioning regimens for acute myelogenous leukaemia in first remission. Br J Haematol 2002;119:1115-24. https://doi.org/10.1046/j.1365-2141.2002.03973.x
  18. Clift RA, Buckner CD, Thomas ED, et al. Marrow transplantation for chronic myeloid leukemia: a randomized study comparing cyclophosphamide and total body irradiation with busulfan and cyclophosphamide. Blood 1994;84:2036-43.
  19. Kang KM, Choi BO, Chai GY, et al. Effect of cytarabine, melphalan, and total body irradiation as conditioning for autologous stem cell transplantation for patients with AML in first remission. J Korean Soc Ther Radiol Oncol 2003;21:192-8.
  20. Ringden O, Ruutu T, Remberger M, et al. A randomized trial comparing busulfan with total body irradiation as conditioning in allogeneic marrow transplant recipients with leukemia: a report from the Nordic Bone Marrow Transplantation Group. Blood 1994;83:2723-30.
  21. Granados E, de La Camara R, Madero L, et al. Hematopoietic cell transplantation in acute lymphoblastic leukemia: better long term event-free survival with conditioning regimens containing total body irradiation. Haematologica 2000;85:1060-7.
  22. Blaise D, Maraninchi D, Archimbaud E, et al. Allogeneic bone marrow transplantation for acute myeloid leukemia in first remission: a randomized trial of a busulfan-Cytoxan versus Cytoxan-total body irradiation as preparative regimen: a report from the Group d'Etudes de la Greffe de Moelle Osseuse. Blood 1992;79:2578-82.
  23. Chou RH, Wong GB, Kramer JH, et al. Toxicities of total-body irradiation for pediatric bone marrow transplantation. Int J Radiat Oncol Biol Phys 1996;34:843-51. https://doi.org/10.1016/0360-3016(95)02178-7
  24. Mateos MK, O'Brien TA, Oswald C, et al. Transplant-related mortality following allogeneic hematopoeitic stem cell transplantation for pediatric acute lymphoblastic leukemia: 25-year retrospective review. Pediatr Blood Cancer 2013;60:1520-7. https://doi.org/10.1002/pbc.24559
  25. Levine JE, Uberti JP, Ayash L, et al. Lowered-intensity preparative regimen for allogeneic stem cell transplantation delays acute graft-versus-host disease but does not improve outcome for advanced hematologic malignancy. Biol Blood Marrow Transplant 2003;9:189-97. https://doi.org/10.1016/S1083-8791(03)70009-3
  26. Cohen A, Rovelli A, Bakker B, et al. Final height of patients who underwent bone marrow transplantation for hematological disorders during childhood: a study by the Working Party for Late Effects-EBMT. Blood 1999;93:4109-15.
  27. Nathan PC, Wasilewski-Masker K, Janzen LA. Long-term outcomes in survivors of childhood acute lymphoblastic leukemia. Hematol Oncol Clin North Am 2009;23:1065-82, vi-vii. https://doi.org/10.1016/j.hoc.2009.07.003
  28. Keane TJ, Van Dyk J, Rider WD. Idiopathic interstitial pneumonia following bone marrow transplantation: the relationship with total body irradiation. Int J Radiat Oncol Biol Phys 1981;7:1365-70. https://doi.org/10.1016/0360-3016(81)90032-8
  29. Shank B, Chu FC, Dinsmore R, et al. Hyperfractionated total body irradiation for bone marrow transplantation: results in seventy leukemia patients with allogeneic transplants. Int J Radiat Oncol Biol Phys 1983;9:1607-11. https://doi.org/10.1016/0360-3016(83)90412-1
  30. Thomas ED, Clift RA, Hersman J, et al. Marrow transplantation for acute nonlymphoblastic leukemia in first remission using fractionated or single-dose irradiation. Int J Radiat Oncol Biol Phys 1982;8:817-21. https://doi.org/10.1016/0360-3016(82)90083-9
  31. Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med 2006;354:1813-26. https://doi.org/10.1056/NEJMra052638
  32. Bhushan V, Collins RH Jr. Chronic graft-vs-host disease. JAMA 2003;290:2599-603. https://doi.org/10.1001/jama.290.19.2599
  33. Hows J, Bradley BA, Gore S, Downie T, Howard M, Gluckman E. Prospective evaluation of unrelated donor bone marrow transplantation. The International Marrow Unrelated Search and Transplant (IMUST) Study. Bone Marrow Transplant 1993;12:371-80.
  34. Sierra J, Storer B, Hansen JA, et al. Unrelated donor marrow transplantation for acute myeloid leukemia: an update of the Seattle experience. Bone Marrow Transplant 2000;26:397-404. https://doi.org/10.1038/sj.bmt.1702519

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