- Purpose: Total body irradiation (TBI) is a common part of the myelo- and immuno-ablative conditioning regimen prior to an allogeneic hematopoietic stem cell transplantation (allo-HSCT). Due to concerns regarding acute and long-term complications, there is currently a decline in otherwise successfully established TBI-based conditioning regimens. Here we present an analysis of patient and treatment data with focus on survival and long-term toxicity.
Methods: Patients with hematologic diseases who received TBI as part of their conditioning regimen prior to allo-HSCT at Frankfurt University Hospital between 1997 and 2015 were identified and retrospectively analyzed.
Results: In all, 285 patients with a median age of 45 years were identified. Median radiotherapy dose applied was 10.5 Gy. Overall survival at 1, 2, 5, and 10 years was 72.6, 64.6, 54.4, and 51.6%, respectively. Median follow-up of patients alive was 102 months. The cumulative incidence of secondary malignancies was 12.3% (n = 35), with hematologic malignancies and skin cancer predominating. A TBI dose ≥ 8 Gy resulted in significantly improved event-free (p = 0.030) and overall survival (p = 0.025), whereas a total dose ≤ 8 Gy and acute myeloid leukemia (AML) diagnosis were associated with significantly increased rates of secondary malignancies (p = 0.003, p = 0.048) in univariate analysis. No significant correlation was observed between impaired renal or pulmonary function and TBI dose.
Conclusion: TBI remains an effective and well-established treatment, associated with distinct late-toxicity. However, in the present study we cannot confirm a dose–response relationship in intermediate dose ranges. Survival, occurrence of secondary malignancies, and late toxicities appear to be subject to substantial confounding in this context.
MetadatenAuthor: | Katharina Sieker, Maximilian FleischmannGND, Martin Trommel, Ulla Ramm, Jörg LicherGND, Gesine BugORCiDGND, Hans MartinORCiD, Hubert ServeORCiDGND, Claus RödelORCiDGND, Panagiotis BalermpasORCiDGND |
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URN: | urn:nbn:de:hebis:30:3-695210 |
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DOI: | https://doi.org/10.1007/s00066-022-01914-5 |
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ISSN: | 1439-099X |
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Parent Title (German): | Strahlentherapie und Onkologie |
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Publisher: | Springer Medizin |
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Place of publication: | Berlin ; Heidelberg |
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Document Type: | Article |
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Language: | English |
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Date of Publication (online): | 2022/03/22 |
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Date of first Publication: | 2022/03/22 |
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Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Release Date: | 2023/06/23 |
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Tag: | Hematopoietic stem cell transplant; Long-term follow-up; Sequelae; TBI; Toxicity |
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Volume: | 198 |
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Issue: | 6 |
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Page Number: | 11 |
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First Page: | 547 |
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Last Page: | 557 |
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Note: | Open Access funding enabled and organized by Projekt DEAL. |
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HeBIS-PPN: | 510041833 |
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Institutes: | Medizin |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Licence (German): | Creative Commons - CC BY - Namensnennung 4.0 International |
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