TLI in pediatric patients

Ocanto, Abrahams; Escribano, A.; Glaria, L.; Rodríguez, Isabel Esteban; Ferrer, C.; Huertas, C.; Pérez, Ana Coca; Morera, R.

doi:10.1007/s12094-019-02205-9

Cited by 8 publications

(11 citation statements)

References 32 publications

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“…One advantage of modern rotational techniques is the possibility to decrease the doses in specific OAR while increasing homogeneous target coverage in the rest of the body at the same time [43][44][45][46][47]. TLI/TMI/TMLI approaches aim to protect even more OAR while specifically delivering the dose in lymphoid / marrow tissues to pursue an anti-leukemic effect [33,34,48], or to induce less graft-versushost-disease [32].…”

Section: Discussionmentioning

confidence: 99%

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Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group

Hoeben

Pazos

Albert³

et al. 2021

Radiotherapy and Oncology

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Background and purpose: To reduce relapse risk, Total Body Irradiation (TBI) is part of conditioning regimens for hematopoietic stem cell transplantation (HSCT) in pediatric acute leukemia. The study purpose was to evaluate clinical practices regarding TBI, such as fractionation, organ shielding and delivery techniques, among SIOPE affiliated radiotherapy centers. Methods: An electronic survey was sent out to 233 SIOPE affiliated centers, containing 57 questions about clinical practice of TBI. Surveys could be answered anonymously. Results: From over 25 countries, 82 responses were collected. For TBI-performing centers, 40/48 irradiated 10 pediatric patients annually (range: 1-2 to >25). Most indications concerned acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Four different fractionation schedules were used, of which 12 Gy in 6 fractions was applied in 91% for ALL and 86% for AML. Dose reduction to the lungs, mostly to a mean dose of 8-10 Gy, was applied by 28/33 centers for ALL and 19/21 centers for AML, in contrast to much less applied dose reduction to the kidneys (7/33 ALL and 7/21 AML), thyroid (2/33 ALL and 2/21 AML), liver (4/33 ALL and 3/21 AML) and lenses (4/33 ALL and 4/21 AML). Conventional TBI techniques were used by 24/29 responding centers, while 5/29 used advanced optimized planning techniques. Conclusion: Across SIOPE, there is a high level of uniformity in fractionation and use of lung shielding. Practices vary regarding other organs-at-risk shielding and implementation of advanced techniques. A SIOPE radiotherapy working group will be established to define international guidelines for pediatric TBI.

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Section: Discussionmentioning

confidence: 99%

“…volumetric modulated arc therapy (VMAT), helical tomotherapy) could be beneficial to achieve both a homogeneous dose delivery to the target volume of the body, and dose reduction for organs-at-risk (OAR) [31,32]. Other approaches to spare OAR are in use as well, such as total marrow and/or lymphoid irradiation (TM(L)I) [32][33][34].…”

mentioning

confidence: 99%

Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group

Hoeben

Pazos

Albert³

et al. 2021

Radiotherapy and Oncology

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“…The recipients were administered a preparative regimen consisting of 8 Gy total lymphoid irradiation (TLI) over four equal fractions, as previously reported, 35 150 mg/m 2 fludarabine over 5 days, thiotepa 10 mg/kg for 1 day, and melphalan 140 mg/m 2 over 2 days. For the patients undergoing a second HSCT because of a previous graft failure, we employed anti‐thymocyte globulin 7.5 mg/kg instead of TLI and treosulfan 14 g/m 2 instead of melphalan.…”

Section: Methodsmentioning

confidence: 99%

The role of early natural killer cell adoptive infusion before engraftment in protecting against human herpesvirus‐6B encephalitis after naïve T‐cell‐depleted allogeneic stem cell transplantation

et al. 2021

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Background Naïve T‐cell‐depleted grafts have been employed as an ex vivo T‐cell depletion (TCD) platform to prevent graft‐versus‐host disease (GvHD) and improve immune reconstitution by providing rapid donor memory T‐cell reconstitution after allogenic hematopoietic stem cell transplantation (allo‐HSCT). CD45RA− memory T cells confer protection against viruses such as cytomegalovirus, Epstein–Barr virus, and adenovirus; however, reports have shown an unexpectedly high incidence of human herpesvirus (HHV)‐6B encephalitis among pediatric allo‐HSCT patients. Methods We report the first 18 consecutive allo‐HSCT, 16 haplo‐HSCT, and two human leukocyte antigen‐matched related donors implanted with naïve TCD grafts. All donors were administered three cell products: first, a CD34+ stem cell product; second, a CD45RA+ TCD graft, followed by an adoptive natural killer (NK) cell infusion within 10 days after HSCT. The study's primary endpoint was the incidence of HHV‐6B encephalitis. Results Engraftment was achieved in 94.5% of cases; 2‐year overall survival, event‐free survival, and GvHD/relapse‐free survival were 87.2% (95% CI 78.6–95.8), 67.3% (95% CI 53.1–81.5), and 64% (95% CI 50.5–78.1), respectively. HHV‐6B reactivation occurred in 7 of the haplo‐HSCT patients, six of who received a cell infusion with an NK/CD4 ratio <2. None of the patients developed encephalitis. Conclusions In this clinical study, we show that early adoptive NK cell infusion after a 45RA+ TCD allo‐HSCT graft is safe and can prevent HHV‐6B encephalitis. We recommend infusing adoptive NK cells after allo‐HSCT using CD45RA+ TCD grafts.

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“…This technique allows a highly conformal dose at the targets while sparing normal tissues and decreasing delivery time compared with traditional IMRT or conformal radiation therapy. Based on these superior characteristics, VMAT has been applied to HCT conditioning treatment using radiotherapy to achieve dose escalation for target organs and dose reduction for organ at risk (OAR) in people (Ocanto et al., 2019; Paix et al., 2018; Springer et al., 2016). To our knowledge, no study has investigated the application of TLI in combination with VMAT in dogs; and the safety and feasibility of such treatment have not been elucidated.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of a nonmyeloablative pretransplant conditioning regimen using total lymphoid irradiation with volumetric modulated arc therapy in healthy dogs: A pilot study

Kim

Hosoya

Fukayama

et al. 2021

Veterinary Medicine & Sci

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TLI in pediatric patients

Cited by 8 publications

References 32 publications

Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group

Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group

The role of early natural killer cell adoptive infusion before engraftment in protecting against human herpesvirus‐6B encephalitis after naïve T‐cell‐depleted allogeneic stem cell transplantation

Safety and efficacy of a nonmyeloablative pretransplant conditioning regimen using total lymphoid irradiation with volumetric modulated arc therapy in healthy dogs: A pilot study

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