Comparison of total body irradiation versus non-total body irradiation containing regimens for de novo acute myeloid leukemia in children

Christopher E. Dandoy, Stella M. Davies, Kwang Woo Ahn, Yizeng He, Anders E. Kolb, John Levine, Stephanie Bo-Subait, Hisham Abdel-Azim, Neel Bhatt, Joseph Chewing, Shahinaz Gadalla, Nicholas Gloude, Robert Hayashi, Nahal R. Lalefar, Jason Law, Margaret MacMillan, Tracy O'Brien, Timothy Prestidge, Akshay Sharma, Peter ShawLena Winestone, Mary Eapen

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1839-1845
Number of pages7
JournalHaematologica
Volume106
Issue number7
DOIs
StatePublished - Jul 2021

Bibliographical note

Funding Information:
The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the U.S. Government.

Publisher Copyright:
© 2021 Ferrata Storti Foundation

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