The Burden of Survivorship on Hematological Patients-Long-Term Analysis of Toxicities after Total Body Irradiation and Allogeneic Stem Cell Transplantation

Abstract

Total body irradiation is an effective conditioning modality before autologous or allogeneic stem cell transplantation. With the whole body being the radiation target volume, a diverse spectrum of toxicities has been reported. This fact prompted us to investigate the long-term sequelae of this treatment concept in a large patient cohort. Overall, 322 patients with acute leukemia or myelodysplastic syndrome with a minimum follow-up of one year were included (the median follow-up in this study was 68 months). Pulmonary, cardiac, ocular, neurological and renal toxicities were observed in 23.9%, 14.0%, 23.6%, 23.9% and 20.2% of all patients, respectively. The majority of these side effects were grades 1 and 2 (64.9-89.2% of all toxicities in the respective categories). The use of 12 Gray total body irradiation resulted in a significant increase in ocular toxicities (p = 0.013) and severe mucositis (p < 0.001). Renal toxicities were influenced by the age at transplantation (relative risk: 1.06, p < 0.001) and disease entity. In summary, total body irradiation triggers a multifaceted, but manageable, toxicity profile. Except for ocular toxicities and mucositis, a 12 Gray regimen did not lead to an increase in long-term side effects.

Keywords: TBI; leukemia; long-term toxicity; survivorship.

Figure 1

Landmark analysis of patients surviving at least one year after TBI-containing alloSCT. Kaplan–Meier curves for cardiac toxicity-free survival (CTFS; (A)) and pulmonary toxicity-free survival (PTFS; (B)) are presented above and their respective courses during follow-up, with 95%-confidence intervals, are indicated in red. Mean values were 169.6 months (M; confidence interval: 159.1–180.0 M) for CTFS and 165.6 M (confidence interval: 152.2–178.9 M) for PTFS.