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Organ sparing total marrow irradiation compared to total body irradiation prior to allogeneic stem cell transplantation

Haraldsson, André LU ; Wichert, Stina LU orcid ; Engström, Per E. LU ; Lenhoff, Stig LU ; Turkiewicz, Dominik LU ; Warsi, Sarah LU ; Engelholm, Silke ; Bäck, Sven LU and Engellau, Jacob LU (2021) In European Journal of Haematology 107(4). p.393-407
Abstract

Objectives: Total body irradiation (TBI) is commonly used prior to hematopoietic stem cell transplantation (HSCT) in myeloablative conditioning regimens. However, TBI may be replaced by total marrow irradiation (TMI) at centres with access to Helical TomoTherapy, a modality that has the advantage of delivering intensity-modulated radiotherapy to long targets such as the entire bone marrow compartment. Toxicity after organ sparing TMI prior to HSCT has not previously been reported compared to TBI or with regard to engraftment data. Methods: We conducted a prospective observational study on 37 patients that received organ sparing TMI prior to HSCT and compared this cohort to retrospective data on 33 patients that received TBI prior to... (More)

Objectives: Total body irradiation (TBI) is commonly used prior to hematopoietic stem cell transplantation (HSCT) in myeloablative conditioning regimens. However, TBI may be replaced by total marrow irradiation (TMI) at centres with access to Helical TomoTherapy, a modality that has the advantage of delivering intensity-modulated radiotherapy to long targets such as the entire bone marrow compartment. Toxicity after organ sparing TMI prior to HSCT has not previously been reported compared to TBI or with regard to engraftment data. Methods: We conducted a prospective observational study on 37 patients that received organ sparing TMI prior to HSCT and compared this cohort to retrospective data on 33 patients that received TBI prior to HSCT. Results: The 1-year graft-versus-host disease-free, relapse-free survival (GRFS) was 67.5% for all patients treated with TMI and 80.5% for patients with matched unrelated donor and treated with TMI, which was a significant difference from historical data on TBI patients with a hazard ratio of 0.45 (P =.03) and 0.24 (P <.01). Engraftment with a platelet count over 20 [K/µL] and 50 [K/µL] was significantly shorter for the TMI group, and neutrophil recovery was satisfactory in both treatment cohorts. There was generally a low occurrence of other treatment-related toxicities. Conclusions: Despite small cohorts, some significant differences were found; TMI as part of the myeloablative conditioning yields a high 1-year GRFS, fast and robust engraftment, and low occurrence of acute toxicity.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ALL, HSCST, TBI, TMI, Tomotherapy
in
European Journal of Haematology
volume
107
issue
4
pages
393 - 407
publisher
Wiley-Blackwell
external identifiers
  • scopus:85108325353
  • pmid:34107104
ISSN
0902-4441
DOI
10.1111/ejh.13675
language
English
LU publication?
yes
id
01cb8053-60dd-415a-9160-a31b249d1413
date added to LUP
2021-07-16 13:19:34
date last changed
2024-06-16 16:14:09
@article{01cb8053-60dd-415a-9160-a31b249d1413,
  abstract     = {{<p>Objectives: Total body irradiation (TBI) is commonly used prior to hematopoietic stem cell transplantation (HSCT) in myeloablative conditioning regimens. However, TBI may be replaced by total marrow irradiation (TMI) at centres with access to Helical TomoTherapy, a modality that has the advantage of delivering intensity-modulated radiotherapy to long targets such as the entire bone marrow compartment. Toxicity after organ sparing TMI prior to HSCT has not previously been reported compared to TBI or with regard to engraftment data. Methods: We conducted a prospective observational study on 37 patients that received organ sparing TMI prior to HSCT and compared this cohort to retrospective data on 33 patients that received TBI prior to HSCT. Results: The 1-year graft-versus-host disease-free, relapse-free survival (GRFS) was 67.5% for all patients treated with TMI and 80.5% for patients with matched unrelated donor and treated with TMI, which was a significant difference from historical data on TBI patients with a hazard ratio of 0.45 (P =.03) and 0.24 (P &lt;.01). Engraftment with a platelet count over 20 [K/µL] and 50 [K/µL] was significantly shorter for the TMI group, and neutrophil recovery was satisfactory in both treatment cohorts. There was generally a low occurrence of other treatment-related toxicities. Conclusions: Despite small cohorts, some significant differences were found; TMI as part of the myeloablative conditioning yields a high 1-year GRFS, fast and robust engraftment, and low occurrence of acute toxicity.</p>}},
  author       = {{Haraldsson, André and Wichert, Stina and Engström, Per E. and Lenhoff, Stig and Turkiewicz, Dominik and Warsi, Sarah and Engelholm, Silke and Bäck, Sven and Engellau, Jacob}},
  issn         = {{0902-4441}},
  keywords     = {{ALL; HSCST; TBI; TMI; Tomotherapy}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{393--407}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{European Journal of Haematology}},
  title        = {{Organ sparing total marrow irradiation compared to total body irradiation prior to allogeneic stem cell transplantation}},
  url          = {{http://dx.doi.org/10.1111/ejh.13675}},
  doi          = {{10.1111/ejh.13675}},
  volume       = {{107}},
  year         = {{2021}},
}