Annals of Medicine (Dec 2022)

Outcomes of allogeneic haematopoietic stem cell transplantation with intensity-modulated total body irradiation by helical tomotherapy: a 2-year prospective follow-up study

  • Tatsuya Konishi,
  • Hiroaki Ogawa,
  • Yuho Najima,
  • Shinpei Hashimoto,
  • Satoshi Kito,
  • Yuya Atsuta,
  • Atsushi Wada,
  • Hiroto Adachi,
  • Ryosuke Konuma,
  • Yuya Kishida,
  • Akihito Nagata,
  • Yuta Yamada,
  • Satoshi Kaito,
  • Junichi Mukae,
  • Atsushi Marumo,
  • Yuma Noguchi,
  • Naoki Shingai,
  • Takashi Toya,
  • Aiko Igarashi,
  • Hiroaki Shimizu,
  • Takeshi Kobayashi,
  • Kazuteru Ohashi,
  • Noriko Doki,
  • Keiko Nemoto Murofushi

DOI
https://doi.org/10.1080/07853890.2022.2125171
Journal volume & issue
Vol. 54, no. 1
pp. 2617 – 2626

Abstract

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Background and objectives Intensity-modulated radiation therapy (IMRT) helps achieve good radiation dose conformity and precise dose evaluation. We conducted a single-centre prospective study to assess the safety and feasibility of total body irradiation with IMRT (IMRT-TBI) using helical tomotherapy in allogeneic haematopoietic stem cell transplantation (allo-HSCT).Patients and methods Thirty-nine adult patients with haematological malignancy (acute lymphoblastic leukaemia [n = 21], chronic myeloid leukaemia [n = 6], mixed phenotype acute leukaemia [n = 5], acute myeloid leukaemia [n = 4], and malignant lymphoma [n = 3]) who received 12 Gy IMRT-TBI were enrolled with a median follow-up of 934.5 (range, 617–1254) d. At the time of transplantation, 33 patients (85%) achieved complete remission. The conditioning regimen used IMRT-TBI (12 Gy in 6 fractions twice daily, for 3 d) and cyclophosphamide (60 mg/kg/d, for 2 d), seven patients were combined with cytarabine, and five with etoposide. We set dose constraints for the lungs, kidneys and lens as the organs at risk.Results The mean doses for the lungs and kidneys were 7.50 and 9.11 Gy, respectively. The mean maximum dose for the lens (right/left) was 5.75/5.87 Gy. The 2-year overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) were 69, 64, 18 and 18%, respectively. Thirty-six patients developed early adverse events (AEs) (including four patients with Grade 3/4 toxicities), most of which were reversible oral mucositis and may partially have been related to IMRT-TBI. However, the incidence of toxicity was comparable to conventional TBI-based conditioning transplantation. None of the patients developed primary graft failure, or Grade III–IV acute graft-versus-host disease (GVHD). In late complications, chronic kidney disease was observed in six patients, a lower incidence compared to conventional TBI-based conditioning transplantation. No radiation pneumonitis or cataracts were observed in any of the patients.Conclusions IMRT-TBI is safe and feasible for haematological malignancies with acceptable clinical outcomes.KEY MESSAGESIMRT-TBI-helical tomotherapy aids in accurate dose calculation and conformity.It could be used without any considerable increase in the rate of TBI-related AEs.Allo-HSCT with IMRT-TBI may be an alternative to conventional TBI for clinical use.

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