TY - JOUR
T1 - Comparison of total body irradiation versus non-total body irradiation containing regimens for de novo acute myeloid leukemia in children
AU - Dandoy, Christopher E.
AU - Davies, Stella M.
AU - Ahn, Kwang Woo
AU - He, Yizeng
AU - Kolb, Anders E.
AU - Levine, John
AU - Bo-Subait, Stephanie
AU - Abdel-Azim, Hisham
AU - Bhatt, Neel
AU - Chewing, Joseph
AU - Gadalla, Shahinaz
AU - Gloude, Nicholas
AU - Hayashi, Robert
AU - Lalefar, Nahal R.
AU - Law, Jason
AU - MacMillan, Margaret
AU - O'Brien, Tracy
AU - Prestidge, Timothy
AU - Sharma, Akshay
AU - Shaw, Peter
AU - Winestone, Lena
AU - Eapen, Mary
N1 - Publisher Copyright:
© 2021 Ferrata Storti Foundation
PY - 2021/7
Y1 - 2021/7
N2 - With limited data comparing hematopoietic cell transplant outcomes between myeloablative total body irradiation (TBI) containing and non-TBI regimens in children with de novo acute myeloid leukemia, the aim of this study was to compare transplant-outcomes between these regimens. Cox regression models were used to compare transplant-outcomes after TBI and non-TBI regimens in 624 children transplanted between 2008 and 2016. Thirty two percent (n=199) received TBI regimens whereas 68% (n=425) received non-TBI regimens. Five-year non-relapse mortality was higher with TBI regimens (22% vs. 11%, P<0.0001) but relapse was lower (23% vs. 37%, P<0.0001) compared to non-TBI regimens. Consequently, overall (62% vs. 60%, P=1.00) and leukemia-free survival (55% vs. 52%, P=0.42) did not differ between treatment groups. Grade 2-3 acute graft versus host disease was higher with TBI regimens (56% vs. 27%, P<0.0001) but not chronic graft versus host disease. The 3-year incidence of gonadal or growth hormone deficiency was higher with TBI regimens (24% vs. 8%, P<0.001) but there were no differences in late pulmonary, cardiac or renal impairment. In the absence of a survival advantage, the choice of TBI or non-TBI regimen merits careful consideration with the data favoring non-TBI regimens to limit the burden of morbidity associated with endocrine dysfunction.
AB - With limited data comparing hematopoietic cell transplant outcomes between myeloablative total body irradiation (TBI) containing and non-TBI regimens in children with de novo acute myeloid leukemia, the aim of this study was to compare transplant-outcomes between these regimens. Cox regression models were used to compare transplant-outcomes after TBI and non-TBI regimens in 624 children transplanted between 2008 and 2016. Thirty two percent (n=199) received TBI regimens whereas 68% (n=425) received non-TBI regimens. Five-year non-relapse mortality was higher with TBI regimens (22% vs. 11%, P<0.0001) but relapse was lower (23% vs. 37%, P<0.0001) compared to non-TBI regimens. Consequently, overall (62% vs. 60%, P=1.00) and leukemia-free survival (55% vs. 52%, P=0.42) did not differ between treatment groups. Grade 2-3 acute graft versus host disease was higher with TBI regimens (56% vs. 27%, P<0.0001) but not chronic graft versus host disease. The 3-year incidence of gonadal or growth hormone deficiency was higher with TBI regimens (24% vs. 8%, P<0.001) but there were no differences in late pulmonary, cardiac or renal impairment. In the absence of a survival advantage, the choice of TBI or non-TBI regimen merits careful consideration with the data favoring non-TBI regimens to limit the burden of morbidity associated with endocrine dysfunction.
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U2 - 10.3324/haematol.2020.249458
DO - 10.3324/haematol.2020.249458
M3 - Article
C2 - 32554562
AN - SCOPUS:85111789371
SN - 0390-6078
VL - 106
SP - 1839
EP - 1845
JO - Haematologica
JF - Haematologica
IS - 7
ER -