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. 2023 May 3:14:20406207231170708.
doi: 10.1177/20406207231170708. eCollection 2023.

The impacts of total body irradiation on umbilical cord blood hematopoietic stem cell transplantation

Hao Wang  1 , Kristin N Berger  2 , Elizabeth L Miller  2 , Wei Fu  1 , Larisa Broglie  3 , Frederick D Goldman  4 , Heiko Konig  5 , Su Jin Lim  1 , Arthur S Berg  2 , Julie-An Talano  3 , Melanie A Comito  2 , Sherif S Farag  5 , Jeffrey J Pu  6   2
Affiliations

The impacts of total body irradiation on umbilical cord blood hematopoietic stem cell transplantation

Hao Wang et al. Ther Adv Hematol. .

Abstract

Background: Umbilical cord blood hematopoietic stem cells are commonly used for hematopoietic system reconstitution in recipients after umbilical cord blood transplantation (UCBT). However, the optimal conditioning regimen for UCBT remains a topic of debate. The exact impact of total body irradiation (TBI) as a part of conditioning regimens remains unknown.

Objectives: The aim of this study was to evaluate the impacts of TBI on UCBT outcomes.

Design: This was a multi-institution retrospective study.

Methods: A retrospective analysis was conducted on the outcomes of 136 patients receiving UCBT. Sixty-nine patients received myeloablative conditioning (MAC), in which 33 underwent TBI and 36 did not, and 67 patients received reduced-intensity conditioning (RIC), in which 43 underwent TBI and 24 did not. Univariate and multivariate analyses were conducted to compare the outcomes and the post-transplant complications between patients who did and did not undergo TBI in the MAC subgroup and RIC subgroup, respectively.

Results: In the RIC subgroup, patients who underwent TBI had superior overall survival (adjusted hazard ratio [aHR] = 0.25, 95% confidence interval [CI]: 0.09-0.66, p = 0.005) and progression-free survival (aHR = 0.26, 95% CI: 0.10-0.66, p = 0.005). However, in the MAC subgroup, there were no statistically significant differences between those receiving and not receiving TBI.

Conclusion: In the setting of RIC in UCBT, TBI utilization can improve overall survival and progression-free survival. However, TBI does not show superiority in the MAC setting.

Keywords: Myeloablative considition; post cord blood hematological stem cell transplant outcome; reduced-intensity condition; total body irradiation; umbilical cord blood hematopoietic stem cell transplantation.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Kaplan–Meier estimate of overall survival comparing patients who did and did not undergo TBI as a part of the pre-UCBT conditioning regimen. (a) Reduced-intensity conditioning (RIC) subgroup (p = 0.04). (b) Myeloablative conditioning (MAC) subgroup (p = 0.67). TBI, total body irradiation; UCBT, umbilical cord blood transplantation.
Figure 2.
Figure 2.
Cumulative incidence of transplant-related mortality of patients who did and did not undergo TBI as a part of pre-umbilical cord blood stem cell transplantation (UCBSCT) conditioning regimen. (a) RIC subgroup (p = 0.02). (b) MAC subgroup (p = 0.88). MAC, myeloablative conditioning; RIC, reduced-intensity conditioning; TBI, total body irradiation.
Figure 3.
Figure 3.
Kaplan-Meier estimate of progression-free survival comparing patients who did and did not undergo TBI as a part of the pre-UCBT conditioning regimen. (a) RIC subgroup (p = 0.09). (b) MAC subgroup (p = 0.41). MAC, myeloablative conditioning; RIC, reduced-intensity conditioning; TBI, total body irradiation; UCBT, umbilical cord blood transplantation.
Figure 4.
Figure 4.
Cumulative incidence of neutrophil engraftment comparing patients who did and did not undergo TBI as a part of the pre-UCBSCT conditioning regimen. (a) RIC subgroup (p = 0.51). (b) MAC subgroup (p = 0.68). MAC, myeloablative conditioning; RIC, reduced-intensity conditioning; TBI, total body irradiation.
Figure 5.
Figure 5.
Cumulative incidence of platelet engraftment comparing patients who did and did not undergo TBI as a part of the pre-UCBSCT conditioning regimen. (a) RIC subgroup (p = 0.09). (b) MAC subgroup (p = 0.05). MAC, myeloablative conditioning; RIC, reduced-intensity conditioning; TBI, total body irradiation.
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