Total body irradiation plus cyclophosphamide<b><i>versus</i></b>busulphan with cyclophosphamide as conditioning regimen for patients with leukemia undergoing allogeneic stem cell transplantation: a meta-analysis

Allogeneic hematopoietic SCT (HSCT) appears to be an efficient tool to cure high-risk AML in first CR but the choice between BUbased or TBI-based conditioning regimens still remains controversial. In order to analyze the impact of conditioning regimen on long-term survival, we conducted a retrospective analysis from French registry data including all consecutive patients under 18 years old (n ¼ 226) from 1980 to 2004 transplanted for AML in CR1 from sibling (n ¼ 142) or matched unrelated donors and given either TBI-1200 cGy and CY 120 mg/kg (TBI-Cy, n ¼ 84) or BU 16 mg/kg and CY 200 mg/kg (BuCy200, n ¼ 142). Patient subgroups were comparable for all criteria except for median age at diagnosis and HSCT and for donor type. Both 5-year OS and disease-free survival (DFS) were significantly better in BuCy200 group (P ¼ 0.02 and 0.005, respectively). In multivariate analysis, both HLA matching and BuCy200 appeared as good prognostic factors for treatment-related mortality and DFS. Grade 2-4 acute GvHD and chronic GvHD rates were statistically higher in TBI-Cy group than in Bu-Cy200 one with a RR at 2 (P ¼ 0.002). In total, Bu-Cy200 conditioning regimen gives better outcome compared with TBI-Cy irrespective of the stem cell source and the donor type.

Section: Discussionmentioning

confidence: 99%

Impact on long-term OS of conditioning regimen in allogeneic BMT for children with AML in first CR: TBI+CY versus BU+CY: a report from the Société Française de Greffe de Moelle et de Thérapie Cellulaire

Berranger

Cousien

Petit

et al. 2013

“…End-organ damage and late effects after TBI Many of the toxicities associated with TBI may result in end-organ damage. These can include cataract formation in 30-40% (80-90% of those receiving a single fraction of 8-10 Gy), 20,45 gonadal failure, 46 thyroid dysfunction, kidney dysfunction 47,48 and decreased bone mineral density. 49 Survivors are at known risk for chronic oral and dental complications after TBI, with xerostomia being reported by patients as having a major impact on quality of life 1 year after BMT.…”

Section: Morbidity Associated With Current Regimens For Tbimentioning

confidence: 99%

“…The use of TBI as a part of conditioning regimens for this type of treatment continues in the modern era, and appears to provide benefit over conditioning with chemotherapy alone in many settings [17][18][19][20] (Table 1). Although huge amounts of progress have been made with regard to optimal BMT methods in the past 50 years, myriad questions regarding technique and outcome remain.…”

Section: Introduction and Historical Perspectivementioning

confidence: 99%

TBI during BM and SCT: review of the past, discussion of the present and consideration of future directions

Hill‐Kayser

Plastaras

Tochner

et al. 2010

TBI has been used widely in the setting of BMT over the past 3 decades. Early research demonstrated feasibility and efficacy in the myeloablative setting, in preparation first for allogenic BMT and later for autologous stem cell rescue. As experience with TBI increased, its dual roles of myeloablation and immunosuppression came to be recognized. Toxicity associated with myeloablative TBI remains significant, and this treatment is generally reserved for younger patients with excellent performance status. Reduced intensity conditioning regimens may be useful to provide immunosuppression for patients who are not candidates for myeloablative treatment. Efforts to reduce toxicity through protection of normal tissue using methods of normal tissue blocking and use of TLI, rather than TBI, continue. In the future, modalities such as helical tomotherapy, proton radiotherapy and radioimmunotherapy, may have roles in delivery of radiation to the BM and lymphoid structures with reduced normal tissue toxicity. With further investigation, these efforts may expand the therapeutic ratio associated with TBI, allowing safer delivery to a broader range of patients.

“…This finding is unsurprising given that the other conditioning regimens, involving radiotherapy and/or chemotherapy, are associated with more pronounced toxicities and side effects. 15,16 Interestingly, we also found that the symptom of fever and the proportion of BM primitive cells were significant predictors of disease-free and overall survival. These are surprising findings that are difficult to explain.…”

Section: Discussionmentioning

confidence: 61%

Efficacy of allogeneic and autologous hematopoietic SCT in patients with AML after first complete remission

Zhao

et al. 2012

The most effective post-first CR1 treatment for patients with AML, allogenic hematopoietic SCT (allo-HSCT) or autologous hematopoietic SCT (HSCT), remains to be conclusively determined. This study aimed to compare the effectiveness of treatment with allo-HSCT or auto-HSCT in patients with AML after CR1. We retrospectively reviewed medical records of 127 patients with AML who received allo-(n ¼ 52) or auto-HSCT (n ¼ 75) after achieving CR1 at a single medical center. The disease-free and overall survival rates and complications were analyzed. During a median follow-up of 1215 days, all patients (100%) in allo-HSCT group and 94.7% of patients in the auto-HSCT group had successful outcomes. The disease-free survival rates were 65.3% and 50.6% for allo-and auto-HSCT groups, respectively (P ¼ 0.158), while the overall survival rates were 65.3% and 54.9%, respectively (P ¼ 0.486). The recurrence rate was higher with auto-HSCT, whereas the GVHD only happened with allo-HSCT. In conclusion, auto-HSCT was as effective as allo-HSCT for the treatment of patients with AML after CR1. This is encouraging given that allo-HSCT is not always feasible in China because of a lack of matching donors.