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.
Fiche publication
Date publication
janvier 2023
Journal
HemaSphere
Auteurs
Membres identifiés du Cancéropôle Est :
Dr LIOURE Bruno
Tous les auteurs :
Spyridonidis A, Labopin M, Savani B, Giebel S, Bug G, Schönland S, Kröger N, Stelljes M, Schroeder T, McDonald A, Blau IW, Bornhäuser M, Rovira M, Bethge W, Neubauer A, Ganser A, Bourhis JH, Edinger M, Lioure B, Wulf G, Schäfer-Eckart K, Arat M, Peric Z, Schmid C, Bazarbachi A, Ciceri F, Nagler A, Mohty M
Lien Pubmed
Résumé
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 ( = 0.008). Patients treated with 8-Gray were older than ones received 12-Gray (median 55.7 versus 40.3 years, < 0.0001) and were more frequently administered in vivo T-cell depletion (71% versus 40%, <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.
Référence
Hemasphere. 2023 01;7(1):e812