Total body irradiation as part of conditioning regimens in childhood leukemia-long-term outcome, toxicity, and secondary malignancies.
Cancer of the blood
Late adverse events
Pediatric
Radiation induced cancer
Survival
Journal
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]
ISSN: 1439-099X
Titre abrégé: Strahlenther Onkol
Pays: Germany
ID NLM: 8603469
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
04
03
2021
accepted:
13
06
2021
pubmed:
21
7
2021
medline:
1
4
2022
entrez:
20
7
2021
Statut:
ppublish
Résumé
Total body irradiation (TBI) is an established part of conditioning regimens prior to stem cell transplantation in childhood leukemia but is associated with long-term toxicity. We retrospectively analyzed survival, long-term toxicity, and secondary malignancies in a pooled cohort of pediatric patients (pts.) treated with the same TBI regimen. Analyzed were 109 pts. treated between September 1996 and November 2015. Conditioning treatment according to EBMT guidelines and the ALL SCTped 2012 FORUM trial consisted of chemotherapy (CT) and TBI with 2 Gy b.i.d. on 3 consecutive days to a total dose of 12 Gy. Median follow-up was 97.9 months (2-228 months). Overall survival (OS) in our cohort at 2, 5, and 10 years was 86.1, 75.5, and 63.0%, respectively. Median survival was not reached. Long-term toxicity developed in 47 pts. After chronically abnormal liver and kidney parameters in 31 and 7 pts., respectively, growth retardation was the most frequent finding as seen in 13 pts. Secondary malignancies were rare (n = 3). TBI-containing conditioning regimens in pediatric stem cell transplantation (SCT) are highly effective. Efforts to replace TBI- with CT-containing regimens have only been successful in subgroups of pts. Although we could show long-term toxicity in 43% of pts., overall survival was 63% at 10 years. Still, long-term effects such as growth retardation can permanently impact the pts.' quality of life and functioning. Along with new substances, efforts should be undertaken to optimize TBI techniques and accompany the treatment by systematic follow-up programs beyond 5 years to improve detection of rare events.
Sections du résumé
BACKGROUND
BACKGROUND
Total body irradiation (TBI) is an established part of conditioning regimens prior to stem cell transplantation in childhood leukemia but is associated with long-term toxicity. We retrospectively analyzed survival, long-term toxicity, and secondary malignancies in a pooled cohort of pediatric patients (pts.) treated with the same TBI regimen.
METHODS
METHODS
Analyzed were 109 pts. treated between September 1996 and November 2015. Conditioning treatment according to EBMT guidelines and the ALL SCTped 2012 FORUM trial consisted of chemotherapy (CT) and TBI with 2 Gy b.i.d. on 3 consecutive days to a total dose of 12 Gy. Median follow-up was 97.9 months (2-228 months).
RESULTS
RESULTS
Overall survival (OS) in our cohort at 2, 5, and 10 years was 86.1, 75.5, and 63.0%, respectively. Median survival was not reached. Long-term toxicity developed in 47 pts. After chronically abnormal liver and kidney parameters in 31 and 7 pts., respectively, growth retardation was the most frequent finding as seen in 13 pts. Secondary malignancies were rare (n = 3).
CONCLUSION
CONCLUSIONS
TBI-containing conditioning regimens in pediatric stem cell transplantation (SCT) are highly effective. Efforts to replace TBI- with CT-containing regimens have only been successful in subgroups of pts. Although we could show long-term toxicity in 43% of pts., overall survival was 63% at 10 years. Still, long-term effects such as growth retardation can permanently impact the pts.' quality of life and functioning. Along with new substances, efforts should be undertaken to optimize TBI techniques and accompany the treatment by systematic follow-up programs beyond 5 years to improve detection of rare events.
Identifiants
pubmed: 34282476
doi: 10.1007/s00066-021-01810-4
pii: 10.1007/s00066-021-01810-4
pmc: PMC8760188
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
33-38Informations de copyright
© 2021. The Author(s).
Références
J Clin Endocrinol Metab. 1998 Feb;83(2):382-95
pubmed: 9467546
N Engl J Med. 1988 Oct 20;319(16):1033-9
pubmed: 3173432
Pediatr Blood Cancer. 2013 Apr;60(4):700-4
pubmed: 22848000
J Natl Cancer Inst. 1993 Jul 21;85(14):1121-8
pubmed: 8320741
Bone Marrow Transplant. 1994 Jan;13(1):59-64
pubmed: 8019454
Radiat Res. 1994 Feb;137(2 Suppl):S17-67
pubmed: 8127952
Biol Blood Marrow Transplant. 2010 Dec;16(12):1674-81
pubmed: 20685399
Int J Radiat Oncol Biol Phys. 2021 Mar 1;109(3):819-829
pubmed: 33075474
Bone Marrow Transplant. 2003 Sep;32(6):543-8
pubmed: 12953124
J Clin Endocrinol Metab. 2004 May;89(5):2192-9
pubmed: 15126541
Chest. 2001 Dec;120(6):1900-6
pubmed: 11742920
N Engl J Med. 1991 Nov 7;325(19):1330-6
pubmed: 1922234
J Natl Cancer Inst. 1993 Jan 6;85(1):25-31
pubmed: 8416252
Int J Radiat Oncol Biol Phys. 1995 Jun 15;32(3):661-70
pubmed: 7790252
Med Phys. 1985 Sep-Oct;12(5):567-74
pubmed: 3900668
Strahlenther Onkol. 2021 Aug;197(8):711-721
pubmed: 33300098
N Engl J Med. 1996 Mar 21;334(12):745-51
pubmed: 8592547
Hematol Oncol Stem Cell Ther. 2011;4(1):17-29
pubmed: 21460603
J Pediatr. 1996 Oct;129(4):544-50
pubmed: 8859261
Lancet. 2000 Sep 16;356(9234):993-7
pubmed: 11041401
Bone Marrow Transplant. 1995 Oct;16(4):571-6
pubmed: 8528174
Blood. 1992 Jan 1;79(1):289-91
pubmed: 1728317
Blood. 1999 Jun 15;93(12):4109-15
pubmed: 10361107
Blood. 1996 May 1;87(9):3633-9
pubmed: 8611687
Bone Marrow Transplant. 1994 Nov;14(5):805-11
pubmed: 7889014
N Engl J Med. 1987 Sep 3;317(10):588-93
pubmed: 3475572
Cancer. 1997 Apr 15;79(8):1617-22
pubmed: 9118048
Radiat Oncol. 2019 Dec 30;14(1):244
pubmed: 31888680
Strahlenther Onkol. 2020 Jun;196(6):561-568
pubmed: 32016495
J Natl Cancer Inst. 1996 Mar 6;88(5):270-8
pubmed: 8614005
Bone Marrow Transplant. 2002 Jan;29(2):129-36
pubmed: 11850707
Bone Marrow Transplant. 2007 Feb;39(4):223-9
pubmed: 17290279
Blood. 1994 Nov 1;84(9):3212-20
pubmed: 7949192
Bone Marrow Transplant. 2007 Jun;39(11):717-23
pubmed: 17401393
Bone Marrow Transplant. 2003 Jun;31(12):1151-6
pubmed: 12796795
Radiat Oncol. 2013 Apr 15;8:92
pubmed: 23587349
N Engl J Med. 1997 Mar 27;336(13):897-904
pubmed: 9070469
J Pediatr. 1993 Jul;123(1):59-64
pubmed: 8320626
Endocr J. 2001 Apr;48(2):133-8
pubmed: 11456258
Lancet Oncol. 2020 Oct;21(10):e477-e487
pubmed: 33002443
Strahlenther Onkol. 2015 May;191(5):413-20
pubmed: 25487695
Bone Marrow Transplant. 2000 Dec;26(11):1205-10
pubmed: 11149732