Clinical significance of low-dose total body irradiation in HLA-mismatched reduced-intensity stem cell transplantation View Full Text


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Article Info

DATE

2019-01-22

AUTHORS

Shin-ichiro Fujiwara, Junya Kanda, Raine Tatara, Hiroyasu Ogawa, Takahiro Fukuda, Hirokazu Okumura, Kazuteru Ohashi, Koji Iwato, Yasunori Ueda, Ken Ishiyama, Tetsuya Eto, Ken-ichi Matsuoka, Hirohisa Nakamae, Makoto Onizuka, Yoshiko Atsuta, Yoshinobu Kanda

ABSTRACT

The significance of low-dose total body irradiation (TBI) in HLA-mismatched reduced-intensity conditioning stem cell transplantation (RICT) remains unknown. We, retrospectively, evaluated the impact of low-dose TBI in patients with hematological malignancies who received first RICT from ≥1 antigen-mismatched donors between 2004 and 2014. Of the 575 patients, 361 patients received low-dose TBI (2 or 4 Gy). There were no significant differences in neutrophil engraftment or platelet recovery between TBI and non-TBI groups. The benefit of low-dose TBI on neutrophil engraftment was not observed in any subgroups. Low-dose TBI was not associated with decreased secondary graft failure. Suppressed mixed chimerism and autologous hematopoiesis by low-dose TBI was observed. There were no significant differences in cumulative incidences of acute GVHD or nonrelapse mortality rates in either group; however, low-dose TBI improved overall survival (OS), especially in patients with high-risk disease, multi-HLA mismatch, and fludarabine/busulfan conditioning. Multivariate analysis demonstrated that low-dose TBI was an independent prognostic factor for OS. Compared with the non-TBI group, 4 Gy TBI, but not 2 Gy TBI, was associated with increased acute GVHD and reduced relapse. These findings suggest that low-dose TBI may be beneficial for patients at high risk for relapse in HLA-mismatched RICT. More... »

PAGES

1327-1336

References to SciGraph publications

  • 2012-12-10. Graft failure in the modern era of allogeneic hematopoietic SCT in BONE MARROW TRANSPLANTATION
  • 2015-07-10. Donor-specific anti-human leukocyte antigen antibodies were associated with primary graft failure after unmanipulated haploidentical blood and marrow transplantation: a prospective study with randomly assigned training and validation sets in JOURNAL OF HEMATOLOGY & ONCOLOGY
  • 2015-03-16. Primary graft failure after myeloablative allogeneic hematopoietic cell transplantation for hematologic malignancies in LEUKEMIA
  • 2007-08-09. Comparison between two fludarabine-based reduced-intensity conditioning regimens before allogeneic hematopoietic stem-cell transplantation: fludarabine/melphalan is associated with higher incidence of acute graft-versus-host disease and non-relapse mortality and lower incidence of relapse than fludarabine/busulfan in LEUKEMIA
  • 2014-12-22. Impact of conditioning intensity and TBI on acute GVHD after hematopoietic cell transplantation in BONE MARROW TRANSPLANTATION
  • 2007-10-01. Unification of Hematopoietic Stem Cell Transplantation Registries in Japan and Establishment of the TRUMP System in INTERNATIONAL JOURNAL OF HEMATOLOGY
  • 2016-02-08. Risk factors and outcome of graft failure after HLA matched and mismatched unrelated donor hematopoietic stem cell transplantation: a study on behalf of SFGM-TC and SFHI in BONE MARROW TRANSPLANTATION
  • 2015-12-07. Impact of low-dose TBI on outcomes of reduced intensity conditioning allogeneic hematopoietic stem cell transplantation for AML in BONE MARROW TRANSPLANTATION
  • 2012-12-03. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics in BONE MARROW TRANSPLANTATION
  • Journal

    TITLE

    Bone Marrow Transplantation

    ISSUE

    8

    VOLUME

    54

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1038/s41409-019-0434-3

    DOI

    http://dx.doi.org/10.1038/s41409-019-0434-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1111605698

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30670824


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