In haematopoietic SCT for acute leukemia TBI impacts on relapse but not survival: results of a multicentre observational study

Abstract

The aim of this study was to determine whether parameters related to TBI impacted upon OS and relapse in patients with acute leukemia in CR who underwent haematopoietic SCT (HSCT) in 11 Italian Radiation Oncology Centres. Data were analysed from 507 patients (313 males; 194 females; median age 15 years; 318 with ALL; 188 with AML; 1 case not recorded). Besides 128 autologous transplants, donors included 192 matched siblings, 74 mismatched family members and 113 unrelated individuals. Autologous and allogeneic transplants were analysed separately. Median follow-up was 40.1 months. TBI schedules and HSCT type were closely related. Uni-and multi-variate analyses showed no parameter was significant for OS or relapse in autologous transplantation. Multivariate analysis showed type of transplant and disease impacted significantly on OS in allogeneic transplantation. Disease, GVHD and TBI dose were risk factors for relapse. This analysis illustrates that Italian Transplant Centre use of TBI is in line with international practice. Most Centres adopted a hyperfractionated schedule that is used worldwide (12 Gy in six fractions over 3 days), which appears to have become standard. TBI doses impacted significantly upon relapse rates.

Prognostic factors and outcomes for pediatric patients receiving an haploidentical relative allogeneic transplant using CD3/CD19-depleted grafts

“…We were not able to identify risk factors for engraftment failure because of the low number of patients. The median time to neutrophil recovery for the patients with engraftment was 13 days (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The median time to platelet engraftment was 10 days (8-70), and the median times to platelet counts of 50 × 10 9 /L and 100 × 10 9 /L were 13 days (9-150) and 15 days (9-150), respectively.…”

“…This finding is in line with that published by other authors who used various conditioning regimens, including serotherapy and/or TBI. [10][11] The use of serotherapy-based conditioning regimens has been associated with delayed immune recovery, particularly CD4 + lymphocyte subsets, which may increase the risk of opportunistic infections during the early phase after transplantation. Moreover, TBI-based regimens are associated with more transplant-related toxicity and more late effects, especially in low-weight pediatric patients.…”

Mixed chimerism in haemoglobinopathies: from risk of graft rejection to immune tolerance

“…Over the last three decades, allogeneic haematopoietic stem cell transplantation (HSCT) has become an important therapeutic tool that can cure life‐threatening diseases affecting children and adults, including a variety of neoplastic and inborn genetic disorders of the haematopoietic system (1–10). Despite improvements in pretransplantation conditioning regimens, disease relapse and graft rejection are among the major causes of treatment failure, together with acute graft‐ versus ‐host disease (aGvHD) and recurrent infections (11–15). The main goal of engraftment monitoring is therefore to determine the presence or absence of residual host cell (RHC) populations after HSCT by means of an extensive panel of genetic loci that is sufficient to differentiate donors from recipients with a quick turnaround time.…”

Hematopoietic SCT in Iranian children 1991–2012

“…41,42 In a study of HSCT in pediatric patients with leukemia in Italian centers, probability of survival at 24-month interval for patients with matched sibling donors was between 60 and 70%. 43 Even though our method of classification in calculating survival was different, majority of donors for our patients were their siblings or other relatives; OS at 24-month interval in the leukemia patients of allogeneic group was also 60-70%. More detailed comparison would be the subject of a separate study.…”