Long-Term Follow-Up of a Randomized Trial of Two Irradiation Regimens for Patients Receiving Allogeneic Marrow Transplants During First Remission of Acute Myeloid Leukemia

Clift, Reginald A.; Buckner, C. D.; Appelbaum, Frederick R.; Sullivan, Keith; Storb, Rainer; Thomas, E. Donnall

doi:10.1182/blood.v92.4.1455

Cited by 146 publications

(49 citation statements)

References 1 publication

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“…Intensification of the preparative regimen is one way to attempt a better control of leukemia: unfortunately, reduction of leukemia relapse may come with increased NRM. In a prospective randomized study comparing total body irradiation 12 Gy versus 15.75 Gy in patients with AML [17], relapse was reduced from 40% with 12 Gy to 15% with 15.75 Gy, but NRM was increased from 18% (12 Gy) to 38% (15.75 Gy). The net result was identical 10-year survival for both 12-Gy and 15.75-Gy patients [17].…”

Section: Discussionmentioning

confidence: 99%

Allogeneic Hemopoietic Stem Cell Transplants in Patients with Acute Myeloid Leukemia (AML) Prepared with Busulfan and Fludarabine (BUFLU) or Thiotepa, Busulfan, and Fludarabine (TBF): A Retrospective Study

Sorà

Grazia

Chiusolo

et al. 2020

Biology of Blood and Marrow Transplantation

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This is a multicenter retrospective comparison of 2 myeloablative conditioning regimens in 454 patients with acute myeloid leukemia (AML) in remission: busulfan (4 days) and fludarabine (BUFLU) versus thiotepa, busulfan, and fludarabine (TBF). Eligible for this study were patients allografted between January 2008 and December 2018 in 10 transplant centers, with AML in first or second remission: 201 patients received BUFLU, whereas 253 received TBF. The 2 groups (BUFLU and TBF) were comparable for age (P = .13) and adverse AML risk factors (P = .3). The TBF group had more second remissions and more haploidentical grafts. The donor type included HLAidentical siblings, unrelated donors, and family haploidentical donors. The 5-year cumulative incidence of nonrelapse mortality (NRM) was 19% for BUFLU and 22% for TBF (P = .8), and the 5-year cumulative incidence of relapse was 30% and 15%, respectively (P = .0004). The 5-year actuarial survival was 51% for BUFLU and 68% for TBF (P = .002). In a multivariate Cox analysis, after correcting for confounding factors, the use of TBF reduced the risk of relapse compared with BUFLU (P = .03) and the risk of death (P = .03). In a matched pair analysis of 108 BUFLU patients matched with 108 TBF patients, with the exclusion of haploidentical grafts, TBF reduced the risk of relapse (P = .006) and there was a trend for improved survival (P = .07). Superior survival of patients receiving TBF as compared with BUFLU is due to a reduced risk of relapse, with comparable NRM. The survival advantage is independent of donor type and AML risk factors.

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Section: Discussionmentioning

confidence: 99%

Allogeneic Hemopoietic Stem Cell Transplants in Patients with Acute Myeloid Leukemia (AML) Prepared with Busulfan and Fludarabine (BUFLU) or Thiotepa, Busulfan, and Fludarabine (TBF): A Retrospective Study

Sorà

Grazia

Chiusolo

et al. 2020

Biology of Blood and Marrow Transplantation

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“…Total body irradiation (TBI) has been conventionally used with chemotherapy as preparatory regime of bone marrow transplantation (BMT) since 1959. (1) It allows immunosuppression to decrease the risk of graft-versus-host disease (GVHD) and also kills malignant cells to help acceptance of donor transplant. (2) Today, TBI is mainly achieved with conventional radiotherapy (RT) using anteroposterior fields and a long source-skin distance (SSD).…”

Section: Introductionmentioning

confidence: 99%

“…Large setup errors (> 1 cm) are likely, even with a patient immobilization system and pretreatment 3D imaging. (1) This could lead to underdose of some regions. It is not possible on the TomoTherapy planning station to modify manually the beam aperture for treatment of the flash region, as recommended in ICRU report 83.…”

Section: Introductionmentioning

confidence: 99%

Virtual bolus for total body irradiation treated with helical tomotherapy

Moliner

Izar²,

Ferrand

et al. 2015

J Applied Clin Med Phys

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Intensity‐modulated radiation therapy (IMRT) for total body irradiation (TBI) is practiced in several centers using the TomoTherapy System. In this context the planning target volume (PTV) is the entire body including the skin. A safety margin in the air surrounding the body should be added to take into account setup errors. But using inverse planning, over‐fluence peak could be generated in the skin region to insure dose homogeneity. This work proposes to study the performance of the use of a virtual bolus (VB). A VB is a material placed on the skin surface during planning, but absent for the real treatment. The optimal VB that compensates large setup errors without introducing a high‐dose increase or hot spots for small setup errors was determined. For two cylindrical phantoms, 20 VBs with different densities, thicknesses or designs were tested. Dose coverage of the PTV (V95%) in the presence of simulated setup errors was computed to assess the VB performance. A measure of the dose increase in the phantom center due to the absence of the VB during treatment was also achieved. Finally, the fluence peak at the phantom edge was measured in complete buildup conditions using a large phantom and a detector matrix. Using these VBs, simulated setup errors were compensated to a minimum value of 2.6 and 2.1 cm for small and large phantom, respectively (and only 1.2 and 1.7 cm with no VB). An optimal double‐layer VB was found with a density of 0.4 kg.normalm−3 and a total thickness of 8 mm; an inner layer of 5 mm was declared as the target for the treatment planning system and an additional layer of 3 mm was added to avoid the over‐fluence peak. Using this VB, setup errors were compensated up to 2.9 cm. The dose increase was measured to be only +1.5% at the phantom center and over‐fluence peak was strongly decreased.PACS numbers: 87.53 Bn, 87.55 D‐, 87.55 de, 87.55 dk

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“…[2][3][4] Higher TBI doses have also been shown to reduce post-transplant relapse rates in patients with chronic and acute myeloid leukemia. 5,6 However, higher doses did not improve overall survival due to excessive toxicity to organs at risk (OAR).…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of helical tomotherapy treatment plans for total marrow irradiation created using GPU and CPU dose calculation engines

Nalichowski

Burmeister

2013

Medical Physics

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Long-Term Follow-Up of a Randomized Trial of Two Irradiation Regimens for Patients Receiving Allogeneic Marrow Transplants During First Remission of Acute Myeloid Leukemia

Cited by 146 publications

References 1 publication

Allogeneic Hemopoietic Stem Cell Transplants in Patients with Acute Myeloid Leukemia (AML) Prepared with Busulfan and Fludarabine (BUFLU) or Thiotepa, Busulfan, and Fludarabine (TBF): A Retrospective Study

Allogeneic Hemopoietic Stem Cell Transplants in Patients with Acute Myeloid Leukemia (AML) Prepared with Busulfan and Fludarabine (BUFLU) or Thiotepa, Busulfan, and Fludarabine (TBF): A Retrospective Study

Virtual bolus for total body irradiation treated with helical tomotherapy

Dosimetric comparison of helical tomotherapy treatment plans for total marrow irradiation created using GPU and CPU dose calculation engines

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