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Title: Reduced-intensity conditioning regimen using low-dose total body irradiation before allogeneic transplant for hematologic malignancies: Experience from the European Group for Blood and Marrow Transplantation

Abstract

Purpose: The high rate of toxicity is the limitation of myelobalative regimens before allogeneic transplantation. A reduced intensity regimen can allow engraftment of stem cells and subsequent transfer of immune cells for the induction of a graft-vs.-tumor reaction. Methods and Materials: The data from 130 patients (80 males and 50 females) treated between 1998 and 2003 for various hematologic malignancies were analyzed. The median patient age was 50 years (range, 3-72 years). Allogeneic transplantation using peripheral blood or bone marrow, or both, was performed in 104 (82%), 22 (17%), and 4 (3%) patients, respectively, from HLA identical sibling donors (n = 93, 72%), matched unrelated donors (n = 23, 18%), mismatched related donors (4%), or mismatched unrelated donors (6%). Total body irradiation (TBI) at a dose of 2 Gy delivered in one fraction was given to 101 patients (78%), and a total dose of 4-6 Gy was given in 29 (22%) patients. The median dose rate was 14.3 cGy/min (range, 6-16.4). Results: After a median follow-up period of 20 months (range, 1-62 months), engraftment was obtained in 122 patients (94%). Acute graft-vs.-host disease of Grade 2 or worse was observed in 37% of patients. Multivariate analysis showed three favorable independentmore » factors for event-free survival: HLA identical sibling donor (p < 0.0001; relative risk [RR], 0.15), complete remission (p < 0.0001; RR, 3.08), and female donor to male patient (p = 0.006; RR 2.43). For relapse, the two favorable prognostic factors were complete remission (p < 0.0001, RR 0.11) and HLA identical sibling donor (p = 0.0007; RR 3.59). Conclusions: In this multicenter study, we confirmed high rates of engraftment and chimerism after the reduced intensity regimen. Our results are comparable to those previously reported. Radiation parameters seem to have no impact on outcome. However, the lack of a statistically significant difference in terms of dose rate may have been due, in part, to the small population size in the subgroup analysis.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [8];  [9];  [10];  [11];  [12]
  1. Oscar Lambret Center and University of Lille II, Lille (France). E-mail: y-belkacemi@o-lambret.fr
  2. European Group for Blood and Marrow Transplantation Office, Paris (France)
  3. Saint Louis Hospital, Paris (France)
  4. Alexis Vautrin Center, Nancy (France)
  5. AZ Ospedaleria, Florence (Italy)
  6. Hadassah University Hospital, Jerusalem (Israel)
  7. Karolinska University Hospital, Stockholm (Sweden)
  8. Klinic Strahlentherapie, Freiburg (Germany)
  9. Christchurch Hospital, Christchurch (New Zealand)
  10. Centre Hospitalier Universitaire de Besancon, Besancon (France)
  11. Department of Radiation-Oncology, Georges Pompidou Hospital, Paris (France)
  12. Department of Bone Marrow Transplantation and Hematology/Oncology, General Hospital, Idar-Oberstein (Germany)
Publication Date:
OSTI Identifier:
20944700
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2006.08.049; PII: S0360-3016(06)02800-8; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLOOD; BONE MARROW; DOSE RATES; GRAFTS; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; RADIATION DOSES; STEM CELLS; TOXICITY; WHOLE-BODY IRRADIATION

Citation Formats

Belkacemi, Yazid, Labopin, Myriam, Hennequin, Christophe, Hoffstetter, Sylvette, Mungai, Raffaello, Wygoda, Marc, Lundell, Marie, Finke, Jurgen, Aktinson, Chris, Lorchel, Frederic, Durdux, Catherine, and Basara, Nadezda. Reduced-intensity conditioning regimen using low-dose total body irradiation before allogeneic transplant for hematologic malignancies: Experience from the European Group for Blood and Marrow Transplantation. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.08.049.
Belkacemi, Yazid, Labopin, Myriam, Hennequin, Christophe, Hoffstetter, Sylvette, Mungai, Raffaello, Wygoda, Marc, Lundell, Marie, Finke, Jurgen, Aktinson, Chris, Lorchel, Frederic, Durdux, Catherine, & Basara, Nadezda. Reduced-intensity conditioning regimen using low-dose total body irradiation before allogeneic transplant for hematologic malignancies: Experience from the European Group for Blood and Marrow Transplantation. United States. doi:10.1016/j.ijrobp.2006.08.049.
Belkacemi, Yazid, Labopin, Myriam, Hennequin, Christophe, Hoffstetter, Sylvette, Mungai, Raffaello, Wygoda, Marc, Lundell, Marie, Finke, Jurgen, Aktinson, Chris, Lorchel, Frederic, Durdux, Catherine, and Basara, Nadezda. Thu . "Reduced-intensity conditioning regimen using low-dose total body irradiation before allogeneic transplant for hematologic malignancies: Experience from the European Group for Blood and Marrow Transplantation". United States. doi:10.1016/j.ijrobp.2006.08.049.
@article{osti_20944700,
title = {Reduced-intensity conditioning regimen using low-dose total body irradiation before allogeneic transplant for hematologic malignancies: Experience from the European Group for Blood and Marrow Transplantation},
author = {Belkacemi, Yazid and Labopin, Myriam and Hennequin, Christophe and Hoffstetter, Sylvette and Mungai, Raffaello and Wygoda, Marc and Lundell, Marie and Finke, Jurgen and Aktinson, Chris and Lorchel, Frederic and Durdux, Catherine and Basara, Nadezda},
abstractNote = {Purpose: The high rate of toxicity is the limitation of myelobalative regimens before allogeneic transplantation. A reduced intensity regimen can allow engraftment of stem cells and subsequent transfer of immune cells for the induction of a graft-vs.-tumor reaction. Methods and Materials: The data from 130 patients (80 males and 50 females) treated between 1998 and 2003 for various hematologic malignancies were analyzed. The median patient age was 50 years (range, 3-72 years). Allogeneic transplantation using peripheral blood or bone marrow, or both, was performed in 104 (82%), 22 (17%), and 4 (3%) patients, respectively, from HLA identical sibling donors (n = 93, 72%), matched unrelated donors (n = 23, 18%), mismatched related donors (4%), or mismatched unrelated donors (6%). Total body irradiation (TBI) at a dose of 2 Gy delivered in one fraction was given to 101 patients (78%), and a total dose of 4-6 Gy was given in 29 (22%) patients. The median dose rate was 14.3 cGy/min (range, 6-16.4). Results: After a median follow-up period of 20 months (range, 1-62 months), engraftment was obtained in 122 patients (94%). Acute graft-vs.-host disease of Grade 2 or worse was observed in 37% of patients. Multivariate analysis showed three favorable independent factors for event-free survival: HLA identical sibling donor (p < 0.0001; relative risk [RR], 0.15), complete remission (p < 0.0001; RR, 3.08), and female donor to male patient (p = 0.006; RR 2.43). For relapse, the two favorable prognostic factors were complete remission (p < 0.0001, RR 0.11) and HLA identical sibling donor (p = 0.0007; RR 3.59). Conclusions: In this multicenter study, we confirmed high rates of engraftment and chimerism after the reduced intensity regimen. Our results are comparable to those previously reported. Radiation parameters seem to have no impact on outcome. However, the lack of a statistically significant difference in terms of dose rate may have been due, in part, to the small population size in the subgroup analysis.},
doi = {10.1016/j.ijrobp.2006.08.049},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 67,
place = {United States},
year = {Thu Feb 01 00:00:00 EST 2007},
month = {Thu Feb 01 00:00:00 EST 2007}
}