title: Long-term results of total body irradiation in adults with acute lymphoblastic leukemia.
abstract: OBJECTIVE
  The aim of this chart review of adult patients treated for acute lymphoblastic leukemia (ALL) with total body irradiation (TBI) was to evaluate early and late toxicity and long-term outcome.
  
  
  METHODS
  A total of 110 adult patients (34 ± 12 years) with ALL underwent TBI (6 fractions of  2 Gy for a total of 12 Gy) as a part of the treatment regimen before transplantation. Treatment-related toxicity, mortality, and hematologic outcome are reported.
  
  
  RESULTS
  Mean follow-up was 70 months. The 2- and 5-year leukemia-free survival rates were 78 and 72%, respectively. In all, 29% (32/110) patients suffered from medullary recurrence after a median time of 7 months. Gender was the only statistically significant prognostic factor in terms of overall survival in favor of female patients. Treatment-related mortality and overall survival after 2 and 5 years were 16 and 22%, and 60 and 52.7%, respectively. The most frequent late reaction wascGVHD of the skin (n = 33, 30%). In addition, 15.5% (17/110 patients) suffered pulmonary symptoms, and 6 patients developed lung fibrosis. Eyes were frequently affected by the radiation (31/110 = 28%); 12 of 110 patients (11%) presented with symptoms from osteoporosis, 5 of 110 patients (4.5%) developed hypothyreosis and 2 patients diabetes mellitus. Of the male patients, 11% reported erectile dysfunction or loss of libido, while 2 of 36 women reported menopausal syndrome at the mean time of 28 months after treatment with requirement for substitution. No women became pregnant after treatment. No acute or late cardiac toxicities were documented in our patients. No secondary malignancies were documented.
  
  
  CONCLUSIONS
  Although hematologic outcome was in the upper range of that reported in the literature, treatment-related mortality (TRM) and medullary recurrences remain a challenge. Sophisticated radiation techniques allow for decreasing toxicity to certain organs and/or dose escalation to the bone marrow in highly selected patients in order to improve therapeutic breadth.
authors.affiliation: Department of Radiation Oncology, Charité University Medicine, Augustenburger Platz 1, 13353, Berlin, Germany, simone.marnitz@charite.de.
authors.forename: Simone
authors.initials: S
authors.lastname: Marnitz
authors.forename: Alexander
authors.initials: A
authors.lastname: Zich
authors.forename: Peter
authors.initials: P
authors.lastname: Martus
authors.forename: Volker
authors.initials: V
authors.lastname: Budach
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jahn
authors.forename: Oliver
authors.initials: O
authors.lastname: Neumann
authors.forename: Renate
authors.initials: R
authors.lastname: Arnold
mesh_terms: D000328:Adult; D016465:Bone Marrow Purging; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D014916:Whole-Body Irradiation