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Reduced 8-Gray Compared to Standard 12-Gray Total Body Irradiation for Allogeneic Transplantation in First Remission Acute Lymphoblastic Leukemia: A Study of the Acute Leukemia Working Party of the EBMT

In this registry-based study, we compared outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) in adult patients with acute lymphoblastic leukemia (ALL) transplanted in first complete remission (CR-1), following conditioning with total body irradiation (TBI) at a standard 12-Gray or...

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Detalles Bibliográficos
Autores principales: Spyridonidis, Alexandros, Labopin, Myriam, Savani, Bipin, Giebel, Sebastian, Bug, Gesine, Schönland, Stefan, Kröger, Nicolaus, Stelljes, Matthias, Schroeder, Thomas, McDonald, Andrew, Blau, Igor-Wolfgang, Bornhäuser, Martin, Rovira, Montse, Bethge, Wolfgang, Neubauer, Andreas, Ganser, Arnold, Bourhis, Jean Henri, Edinger, Matthias, Lioure, Bruno, Wulf, Gerald, Schäfer-Eckart, Kerstin, Arat, Mutlu, Peric, Zinaida, Schmid, Christoph, Bazarbachi, Ali, Ciceri, Fabio, Nagler, Arnon, Mohty, Mohamad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9831184/
https://www.ncbi.nlm.nih.gov/pubmed/36698616
http://dx.doi.org/10.1097/HS9.0000000000000812
Descripción
Sumario:In this registry-based study, we compared outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) in adult patients with acute lymphoblastic leukemia (ALL) transplanted in first complete remission (CR-1), following conditioning with total body irradiation (TBI) at a standard 12-Gray or at a lower 8-Gray total dose. Patients received fludarabine (flu) as the sole chemotherapy complementing TBI. Eight-Gray TBI/flu was used in 494 patients and 12-Gray TBI/flu in 145 patients. Eighty-eight (23.1%) and 36 (29%) of the patients had Ph-negative B-ALL, 222 (58.3%) and 53 (42.7%) had Ph-positive B-ALL, 71 (18.6%) and 35 (28.2%) T-ALL, respectively (P = 0.008). Patients treated with 8-Gray were older than ones received 12-Gray (median 55.7 versus 40.3 years, P < 0.0001) and were more frequently administered in vivo T-cell depletion (71% versus 40%, P <0.0001). In a multivariate model adjusted for age, type of ALL, and other prognostic factors, leukemia-free survival (primary endpoint) as well as relapse, nonrelapse mortality, overall survival, and GVHD-free, relapse-free survival were not influenced by the TBI dose. These results were confirmed when we focused on patients <55 years of age (median 47 years). Patients with Ph-positive ALL or T-ALL had significantly better survival outcomes than ones with Ph-negative B-ALL, mainly due to significantly fewer relapses. We conclude that 8-Gray TBI is sufficient for adult patients with ALL transplanted in CR-1 with no additional benefit of augmenting the conditioning intensity to 12-Gray.