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Acute Myeloid Leukemia
Comparison of total body irradiation versus non-total body irradiation containing regimens for de novo acute myeloid leukemia in children
Ferrata Storti Foundation
Haematologica 2021 Volume 106(7):1839-1845
Christopher E. Dandoy,1,2 Stella M. Davies,1,2 Kwang Woo Ahn,3 Yizeng He,3 Anders E. Kolb,4 John Levine,5 Stephanie Bo-Subait,6 Hisham Abdel-Azim,7 Neel Bhatt,8 Joseph Chewing,9 Shahinaz Gadalla,10 Nicholas Gloude,11 Robert Hayashi,12 Nahal R. Lalefar,13 Jason Law,14 Margaret MacMillan,15 Tracy O’Brien,16 Timothy Prestidge,17 Akshay Sharma,18 Peter Shaw,19 Lena Winestone20 and Mary Eapen21
1Division of Hematology-Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA; 2Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA; 3Division of Biostatics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; 4Division of Hematology-Oncology, Alfred I. duPont Hospital for Children, Wilmington, DE, USA; 5Blood and Marrow Transplant Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 6Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA; 7Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; 8Division of Clinical Research, Department of Data Abstraction, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; 9Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, USA; 10Division of Cancer Epidemiology & Genetics, NIH-NCI Clinical Genetics Branch, Rockville, MD, USA 11Division of Hematology-Oncology, Rady Children’s Hospital San Diego, San Diego, CA, USA; 12Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; 13Division of Hematology- Oncology, Children’s Hospital and Research Center Oakland, Oakland, CA, USA; 14Division of Pediatric Hematology-Oncology, Tufts Medical Center, Boston, MA, USA; 15Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; 16Blood & Marrow Transplant Program, Kids Cancer Center, Sydney Children's Hospital, Sydney, New South Wales, Australia; 17Blood and Cancer Center, Starship Children’s Hospital, Auckland, New Zealand; 18Division of Bone and Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, USA; 19The Children’s Hospital at Westmead, Westmead, New South Wales, Australia; 20Division of Hematology-Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA and 21Division of Hematology-Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
ABSTRACT
With limited data comparing hematopoietic cell transplant out- comes between myeloablative total body irradiation (TBI) con- taining and non-TBI regimens in children with de novo acute myeloid leukemia, the aim of this study was to compare transplant-out- comes between these regimens. Cox regression models were used to com- pare transplant-outcomes after TBI and non-TBI regimens in 624 children transplanted between 2008 and 2016. Thirty two percent (n=199) received TBI regimens whereas 68% (n=425) received non-TBI regimens. Five-year non-relapse mortality was higher with TBI regimens (22% vs. 11%, P<0.0001) but relapse was lower (23% vs. 37%, P<0.0001) compared to non-TBI regimens. Consequently, overall (62% vs. 60%, P=1.00) and leukemia-free survival (55% vs. 52%, P=0.42) did not differ between treat- ment groups. Grade 2-3 acute graft versus host disease was higher with TBI regimens (56% vs. 27%, P<0.0001) but not chronic graft versus host dis- ease. The 3-year incidence of gonadal or growth hormone deficiency was higher with TBI regimens (24% vs. 8%, P<0.001) but there were no differ- ences in late pulmonary, cardiac or renal impairment. In the absence of a survival advantage, the choice of TBI or non-TBI regimen merits careful consideration with the data favoring non-TBI regimens to limit the burden of morbidity associated with endocrine dysfunction.
Correspondence:
MARY EAPEN
meapen@mcw.edu
Received: February 6, 2020. Accepted: June 12, 2020. Pre-published: June 18, 2020.
https://doi.org/10.3324/haematol.2020.249458
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