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

on behalf of the HLA Working Group of the Japan Society for Hematopoietic Cell Transplantation

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalBone Marrow Transplantation
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Whole-Body Irradiation
Stem Cell Transplantation
Neutrophils
Recurrence
Busulfan
Chimerism
Survival
Hematopoiesis
Hematologic Neoplasms
Blood Platelets
Multivariate Analysis
Tissue Donors

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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Clinical significance of low-dose total body irradiation in HLA-mismatched reduced-intensity stem cell transplantation. / on behalf of the HLA Working Group of the Japan Society for Hematopoietic Cell Transplantation.

In: Bone Marrow Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

on behalf of the HLA Working Group of the Japan Society for Hematopoietic Cell Transplantation. / Clinical significance of low-dose total body irradiation in HLA-mismatched reduced-intensity stem cell transplantation. In: Bone Marrow Transplantation. 2019.
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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.",
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