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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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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 |
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author | 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 |
author_facet | 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 |
author_sort | Spyridonidis, Alexandros |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9831184 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-98311842023-01-24 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 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 Hemasphere Article 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. Lippincott Williams & Wilkins 2023-01-09 /pmc/articles/PMC9831184/ /pubmed/36698616 http://dx.doi.org/10.1097/HS9.0000000000000812 Text en Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Hematology Association. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Article 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 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 |
title | 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 |
title_full | 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 |
title_fullStr | 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 |
title_full_unstemmed | 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 |
title_short | 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 |
title_sort | 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 |
topic | Article |
url | 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 |
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