Treatment of Pediatric CNS Leukemia With Cranial or Craniospinal Boost in Conjunction With Total Body Irradiation as Part of the Conditioning Regimen for Bone Marrow Transplantation

Grow, J.L.; Stea, Baldassarre; Katsanis, Emmanuel

doi:10.1016/j.ijrobp.2016.06.418

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“…Previous evidence on the benefit of a cranial boost has been limited. Grow et al demonstrated in a retrospective analysis of 26 patients that a cranial or craniospinal boost protects against CNS recurrence 19 . Another retrospective study performed by Su et al concluded that a 600 cGy boost, in addition to 1200 cGy TBI, is well-tolerated and may reduce the likelihood of CNS recurrence 20 .…”

Section: Discussionmentioning

confidence: 99%

Augmenting Total Body Irradiation with a Cranial Boost before Stem Cell Transplantation Protects Against Post-Transplant Central Nervous System Relapse in Acute Lymphoblastic Leukemia

Gao

Dusenbery

Cao

et al. 2018

Biology of Blood and Marrow Transplantation

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The purpose of this study was to determine the effect of a pretransplant cranial boost (CB) on post-transplant central nervous system (CNS) relapse and survival in acute lymphoblastic leukemia (ALL) patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) using a total body irradiation (TBI)-containing preparation regimen. Two hundred thirteen ALL patients were treated consecutively at our institution with allogeneic HSCT. Conditioning included TBI (1320 cGy in 8 fractions given twice daily) and cyclophosphamide (120 mg/kg) with or without fludarabine (75 mg/m). Patients were divided into 4 groups based on history of CNS disease and whether a CB was given. Of the 160 patients with no history of CNS disease, none received a CB (CNS-/CB-). Of the 53 patients with prior CNS disease, 41 had not received prior cranial irradiation. Thirty of these 41 received a CB of 900 to 1000 cGy in 5 daily fractions (CNS+/CB+), whereas the other 11 did not receive a CB because of physician preference (CNS+/CB-). The remaining 12 patients with prior CNS involvement had previously received cranial irradiation and thus were not candidates for a CB (CNS + PriorRT). Two-year CNS relapse risk, overall survival (OS), and disease-free survival (DFS) were calculated using Kaplan-Meier analysis. Seven patients experienced post-transplant CNS relapse: 4 in the CNS-/CB- group, 2 in the CNS+/CB- group, and 1 in the CNS + PriorRT group. None of the 30 patients who received a CB relapsed in the CNS. Two-year CNS relapse risk was 0% in the CNS+/CB+ group compared with 21% (95% CI, 0% to 45%) in the CNS+/CB- group (P = .03). Two-year OS and DFS did not differ between the groups. In conclusion, among ALL patients with prior CNS leukemia, there was a trend toward a reduced risk of post-transplant CNS relapse in patients who received a CB. However, the addition of a CB did not appear to have an impact on OS or DFS.

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Section: Discussionmentioning

confidence: 99%