Reduced 8-Gray Compared to Standard 12-Gray Total Body Irradiation for Allogeneic Transplantation in First Remission Acute Lymphoblastic Leukemia: A Study of the Acute Leukemia Working Party of the EBMT
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Reduced 8-Gray Compared to Standard 12-Gray Total Body Irradiation for Allogeneic Transplantation in First Remission Acute Lymphoblastic Leukemia: A Study of the Acute Leukemia Working Party of the EBMT. / Spyridonidis, Alexandros; Labopin, Myriam; Savani, Bipin; Giebel, Sebastian; Bug, Gesine; Schönland, Stefan; Kröger, Nicolaus; Stelljes, Matthias; Schroeder, Thomas; McDonald, Andrew; Blau, Igor-Wolfgang; Bornhäuser, Martin; Rovira, Montse; Bethge, Wolfgang; Neubauer, Andreas; Ganser, Arnold; Bourhis, Jean Henri; Edinger, Matthias; Lioure, Bruno; Wulf, Gerald; Schäfer-Eckart, Kerstin; Arat, Mutlu; Peric, Zinaida; Schmid, Christoph; Bazarbachi, Ali; Ciceri, Fabio; Nagler, Arnon; Mohty, Mohamad.
In: HEMASPHERE, Vol. 7, No. 1, 01.2023, p. e812.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Reduced 8-Gray Compared to Standard 12-Gray Total Body Irradiation for Allogeneic Transplantation in First Remission Acute Lymphoblastic Leukemia: A Study of the Acute Leukemia Working Party of the EBMT
AU - Spyridonidis, Alexandros
AU - Labopin, Myriam
AU - Savani, Bipin
AU - Giebel, Sebastian
AU - Bug, Gesine
AU - Schönland, Stefan
AU - Kröger, Nicolaus
AU - Stelljes, Matthias
AU - Schroeder, Thomas
AU - McDonald, Andrew
AU - Blau, Igor-Wolfgang
AU - Bornhäuser, Martin
AU - Rovira, Montse
AU - Bethge, Wolfgang
AU - Neubauer, Andreas
AU - Ganser, Arnold
AU - Bourhis, Jean Henri
AU - Edinger, Matthias
AU - Lioure, Bruno
AU - Wulf, Gerald
AU - Schäfer-Eckart, Kerstin
AU - Arat, Mutlu
AU - Peric, Zinaida
AU - Schmid, Christoph
AU - Bazarbachi, Ali
AU - Ciceri, Fabio
AU - Nagler, Arnon
AU - Mohty, Mohamad
N1 - Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Hematology Association.
PY - 2023/1
Y1 - 2023/1
N2 - In this registry-based study, we compared outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) in adult patients with acute lymphoblastic leukemia (ALL) transplanted in first complete remission (CR-1), following conditioning with total body irradiation (TBI) at a standard 12-Gray or at a lower 8-Gray total dose. Patients received fludarabine (flu) as the sole chemotherapy complementing TBI. Eight-Gray TBI/flu was used in 494 patients and 12-Gray TBI/flu in 145 patients. Eighty-eight (23.1%) and 36 (29%) of the patients had Ph-negative B-ALL, 222 (58.3%) and 53 (42.7%) had Ph-positive B-ALL, 71 (18.6%) and 35 (28.2%) T-ALL, respectively (P = 0.008). Patients treated with 8-Gray were older than ones received 12-Gray (median 55.7 versus 40.3 years, P < 0.0001) and were more frequently administered in vivo T-cell depletion (71% versus 40%, P <0.0001). In a multivariate model adjusted for age, type of ALL, and other prognostic factors, leukemia-free survival (primary endpoint) as well as relapse, nonrelapse mortality, overall survival, and GVHD-free, relapse-free survival were not influenced by the TBI dose. These results were confirmed when we focused on patients <55 years of age (median 47 years). Patients with Ph-positive ALL or T-ALL had significantly better survival outcomes than ones with Ph-negative B-ALL, mainly due to significantly fewer relapses. We conclude that 8-Gray TBI is sufficient for adult patients with ALL transplanted in CR-1 with no additional benefit of augmenting the conditioning intensity to 12-Gray.
AB - In this registry-based study, we compared outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) in adult patients with acute lymphoblastic leukemia (ALL) transplanted in first complete remission (CR-1), following conditioning with total body irradiation (TBI) at a standard 12-Gray or at a lower 8-Gray total dose. Patients received fludarabine (flu) as the sole chemotherapy complementing TBI. Eight-Gray TBI/flu was used in 494 patients and 12-Gray TBI/flu in 145 patients. Eighty-eight (23.1%) and 36 (29%) of the patients had Ph-negative B-ALL, 222 (58.3%) and 53 (42.7%) had Ph-positive B-ALL, 71 (18.6%) and 35 (28.2%) T-ALL, respectively (P = 0.008). Patients treated with 8-Gray were older than ones received 12-Gray (median 55.7 versus 40.3 years, P < 0.0001) and were more frequently administered in vivo T-cell depletion (71% versus 40%, P <0.0001). In a multivariate model adjusted for age, type of ALL, and other prognostic factors, leukemia-free survival (primary endpoint) as well as relapse, nonrelapse mortality, overall survival, and GVHD-free, relapse-free survival were not influenced by the TBI dose. These results were confirmed when we focused on patients <55 years of age (median 47 years). Patients with Ph-positive ALL or T-ALL had significantly better survival outcomes than ones with Ph-negative B-ALL, mainly due to significantly fewer relapses. We conclude that 8-Gray TBI is sufficient for adult patients with ALL transplanted in CR-1 with no additional benefit of augmenting the conditioning intensity to 12-Gray.
U2 - 10.1097/HS9.0000000000000812
DO - 10.1097/HS9.0000000000000812
M3 - SCORING: Journal article
C2 - 36698616
VL - 7
SP - e812
JO - HEMASPHERE
JF - HEMASPHERE
SN - 2572-9241
IS - 1
ER -
