• Int. J. Radiat. Oncol. Biol. Phys. · Nov 2016

    The Total Body Irradiation Schedule Affects Acute Leukemia Relapse After Matched T Cell-Depleted Hematopoietic Stem Cell Transplantation.

    • Cynthia Aristei, Alessandra Carotti, Elisa Palazzari, Lucia Amico, Loredana Ruggeri, Elisabetta Perrucci, Lorenzo Falcinelli, Valentina Lancellotta, Isabella Palumbo, Franca Falzetti, Franco Aversa, Mara Merluzzi, Andrea Velardi, and Massimo Fabrizio Martelli.
    • Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy. Electronic address: cynthia.aristei@unipg.it.
    • Int. J. Radiat. Oncol. Biol. Phys. 2016 Nov 15; 96 (4): 832-839.

    PurposeWe sought to determine whether the total body irradiation (TBI) schedule affected outcome in patients with acute leukemia in complete remission who received T cell-depleted allogeneic hematopoietic stem cell transplantation from HLA identical siblings.Methods And MaterialsThe study recruited 55 patients (median age, 48 years; age range, 20-66 years; 30 men and 25 women; 34 with acute myeloid leukemia and 21 with acute lymphoid leukemia). Hyperfractionated TBI (HTBI) (1.2 Gy thrice daily for 4 days [for a total dose of 14.4 Gy] from day -12 to day -9) was administered to 29 patients. Single-dose TBI (STBI) (8 Gy, at a median dose rate of 10.7 cGy/min on day -9) was given to 26 patients.ResultsAll patients achieved primary, sustained engraftment with full donor-type chimerism. At 10 years, the overall cumulative incidence of transplant-related mortality was 11% (SE, ±0.1%). It was 7% (SE, ±0.2%) after HTBI and 15% (SE, ±0.5%) after STBI (P=.3). The overall cumulative incidence of relapse was 33% (SE, ±0.5). It was 13% (SE, ±0.5%) after HTBI and 46% (SE, ±1%) after STBI (P=.02). The overall probability of disease-free survival (DFS) was 59% (SE, ±7%). It was 67% (SE, ±0.84%) after HTBI and 37% (SE, ±1.4%) after STBI (P=.01). Multivariate analyses showed the TBI schedule was the only risk factor that significantly affected relapse and DFS (P=.01 and P=.03, respectively).ConclusionsIn patients with acute leukemia, HTBI is more efficacious than STBI in eradicating minimal residual disease after HLA-matched T cell-depleted hematopoietic stem cell transplantation, thus affecting DFS.Copyright © 2016 Elsevier Inc. All rights reserved.

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