Similar survival for patients undergoing reduced-intensity total body irradiation (TBI) versus myeloablative TBI as conditioning for allogeneic transplant in acute leukemia.
OBJECTIVE
Hematopoietic stem cell transplantation (HSCT) is the mainstay of treatment for adults with acute leukemia. Total body irradiation (TBI) remains an important part of the conditioning regimen for HCST. For those patients unable to tolerate myeloablative TBI (mTBI), reduced intensity TBI (riTBI) is commonly used. In this study we compared outcomes of patients undergoing mTBI with those of patients undergoing riTBI in our institution.


METHODS
We performed a retrospective review of all patients with acute leukemia who underwent TBI-based conditioning, using a prospectively acquired database of HSCT patients treated at our institution. Patient data including details of the transplantation procedure, disease status, Karnofsky performance status (KPS), response rates, toxicity, survival time, and time to progression were extracted. Patient outcomes for various radiation therapy regimens were examined. Descriptive statistical analysis was performed.


RESULTS
Between June 1985 and July 2012, 226 patients with acute leukemia underwent TBI as conditioning for HSCT. Of those patients, 180 had full radiation therapy data available; 83 had acute lymphoblastic leukemia and 94 had acute myelogenous leukemia; 45 patients received riTBI, and 135 received mTBI. Median overall survival (OS) was 13.7 months. Median relapse-free survival (RFS) for all patients was 10.2 months. Controlling for age, sex, KPS, disease status, and diagnosis, there were no significant differences in OS or RFS between patients who underwent riTBI and those who underwent mTBI (P=.402, P=.499, respectively). Median length of hospital stay was shorter for patients who received riTBI than for those who received mTBI (16 days vs 23 days, respectively; P<.001), and intensive care unit admissions were less frequent following riTBI than mTBI (2.22% vs 12.69%, respectively, P=.043). Nonrelapse survival rates were also similar (P=.186).


CONCLUSIONS
No differences in OS or RFS were seen between all patients undergoing riTBI and those undergoing mTBI, despite older age and potential increased comorbidity of riTBI patients. riTBI regimens were associated with shorter length of hospital stay, fewer intensive care unit admissions, and similar rates of nonrelapse survival, which may reflect reduced toxicity. Prospective trials comparing riTBI and mTBI are warranted.
Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia. Electronic address: jmikell@emory.edu.
John L
JL
Mikell
Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Edmund K
EK
Waller
Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Jeffrey M
JM
Switchenko
Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Sravanti
S
Rangaraju
Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Zahir
Z
Ali
Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Michael
M
Graiser
Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
William A
WA
Hall
Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Amelia A
AA
Langston
Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Natia
N
Esiashvili
Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
H Jean
HJ
Khoury
Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Mohammad K
MK
Khan
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D064591:Allografts; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017567:Karnofsky Performance Status; D007902:Length of Stay; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014916:Whole-Body Irradiation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
D007166:Immunosuppressive Agents