Cargando…

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...

Descripción completa

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
_version_ 1784867807218892800
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
work_keys_str_mv AT spyridonidisalexandros reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT labopinmyriam reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT savanibipin reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT giebelsebastian reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT buggesine reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT schonlandstefan reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT krogernicolaus reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT stelljesmatthias reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT schroederthomas reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT mcdonaldandrew reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT blauigorwolfgang reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT bornhausermartin reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT roviramontse reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT bethgewolfgang reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT neubauerandreas reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT ganserarnold reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT bourhisjeanhenri reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT edingermatthias reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT liourebruno reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT wulfgerald reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT schafereckartkerstin reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT aratmutlu reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT periczinaida reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT schmidchristoph reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT bazarbachiali reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT cicerifabio reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT naglerarnon reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt
AT mohtymohamad reduced8graycomparedtostandard12graytotalbodyirradiationforallogeneictransplantationinfirstremissionacutelymphoblasticleukemiaastudyoftheacuteleukemiaworkingpartyoftheebmt