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. 2021 Jul 1;106(7):1839-1845.
doi: 10.3324/haematol.2020.249458.

Comparison of total body irradiation versus non-total body irradiation containing regimens for de novo acute myeloid leukemia in children

Christopher E Dandoy  1 , Stella M Davies  1 , Kwang Woo Ahn  2 , Yizeng He  2 , Anders E Kolb  3 , John Levine  4 , Stephanie Bo-Subait  5 , Hisham Abdel-Azim  6 , Neel Bhatt  7 , Joseph Chewning  8 , Shahinaz Gadalla  9 , Nicholas Gloude  10 , Robert Hayashi  11 , Nahal R Lalefar  12 , Jason Law  13 , Margaret MacMillan  14 , Tracy O'Brien  15 , Timothy Prestidge  16 , Akshay Sharma  17 , Peter Shaw  18 , Lena Winestone  19 , Mary Eapen  20
Affiliations

Comparison of total body irradiation versus non-total body irradiation containing regimens for de novo acute myeloid leukemia in children

Christopher E Dandoy et al. Haematologica. .

Abstract

With limited data comparing hematopoietic cell transplant outcomes between myeloablative total body irradiation (TBI) containing and non-TBI regimens in children with de novo acute myeloid leukemia, the aim of this study was to compare transplant-outcomes between these regimens. Cox regression models were used to compare transplant-outcomes after TBI and non-TBI regimens in 624 children transplanted between 2008 and 2016. Thirty two percent (n=199) received TBI regimens whereas 68% (n=425) received non-TBI regimens. Five-year non-relapse mortality was higher with TBI regimens (22% vs. 11%, p<0.0001) but relapse was lower (23% vs. 37%, p<0.0001) compared to non-TBI regimens. Consequently, overall (62% vs. 60%, p=1.00) and leukemia-free survival (55% vs. 52%, p=0.42) did not differ between treatment groups. Grade II-IV acute GVHD was higher with TBI regimens (56% vs. 27%, p<0.0001) but not chronic GVHD. The 3-year incidence of gonadal or growth hormone deficiency was higher with TBI regimens (24% vs. 8%, p<0.001) but there were no differences in late pulmonary, cardiac or renal impairment. In the absence of a survival advantage, the choice of TBI or non-TBI regimen merits careful consideration with the data favoring non-TBI regimens to limit the burden of morbidity associated with endocrine dysfunction.

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Figures

Figure 1.
Figure 1.
Non-relapse mortality and relapse. (A) Cumulative incidence of non-relapse mortality with total body irradiation (TBI)-containing and non-TBI regimens, (B) cumulative incidence of relapse with TBI-containing and non-TBI regimens.
Figure 2.
Figure 2.
Leukemia-free survival and overall survival. (A) Probability of overall survival with total body irradiation (TBI)-containing and non-TBI regimens, (B) probability of leukemia-free survival with TBI-containing and non-TBI regimens.
See this image and copyright information in PMC

References

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