Results of hematopoietic stem cell transplantation after treatment with different high-dose total-body irradiation regimens in five Dutch centers.
OBJECTIVE
To evaluate results of high-dose total-body irradiation (TBI) regimens for hematopoietic stem cell transplantation.


METHODS
A total of 1,032 patients underwent TBI in one or two fractions before autologous or allogeneic hematologic stem cell transplantation for acute leukemia and non-Hodgkin's lymphoma. The TBI regimens were normalized by using the biological effective dose (BED) concept. The BED values were divided into three dose groups. Study end points were relapse incidence (RI), non-relapse mortality (NRM), relapse-free survival (RFS), and overall survival (OS). Multivariate analysis was performed, stratified by disease.


RESULTS
In the highest TBI dose group, RI was significantly lower and NRM was higher vs. the lower dose groups. However, a significant influence on RFS and OS was not found. Relapses in the eye region were found only after shielding to very low doses. Age was of significant influence on OS, RFS, and NRM in favor of younger patients. The NRM of patients older than 40 years significantly increased, and OS decreased. There was no influence of age on RI. Men had better OS and RFS and lower NRM. Type of transplantation significantly influenced RI and NRM for patients with acute leukemia and non-Hodgkin's lymphoma. There was no influence on RFS and OS.


CONCLUSIONS
Both RI and NRM were significantly influenced by the size of the BED of single-dose or two-fraction TBI regimens; OS and RFS were not. Age was of highly significant influence on NRM, but there was no influence of age on RI. Hyperfractionated TBI with a high BED might be useful, assuming NRM can be reduced.
van Kempen-Harteveld
M Loes
ML
Department of Radiotherapy, University Medical Center, Utrecht, The Netherlands. mlvankempen@tiscali.nl
Brand
Ronald
R
Kal
Henk B
HB
Verdonck
Leo F
LF
Hofman
Pieter
P
Schattenberg
Anton V
AV
van der Maazen
Richard W
RW
Cornelissen
Jan J
JJ
Eijkenboom
Wil M H
WM
van der Lelie
Johannes P
JP
Oldenburger
Foppe
F
Barge
Renée M
RM
van Biezen
Anja
A
Vossen
Jaak M J J
JM
Noordijk
Evert M
EM
Struikmans
Henk
H
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011835:Radiation Protection / Q000379:methods; D012008:Recurrence; D012062:Relative Biological Effectiveness; D012737:Sex Factors; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000401:mortality