Haematologica (Jun 2020)

Comparison of total body irradiation <i>versus</i> non-total body irradiation containing regimens for <i>de novo</i> acute myeloid leukemia in children

  • Christopher E. Dandoy,
  • Stella M. Davies,
  • Kwang Woo Ahn,
  • Yizeng He,
  • Anders E. Kolb,
  • John Levine,
  • Stephanie Bo-Subait,
  • Hisham Abdel-Azim,
  • Neel Bhatt,
  • Joseph Chewning,
  • Shahinaz Gadalla,
  • Nicholas Gloude,
  • Robert Hayashi,
  • Nahal R. Lalefar,
  • Jason Law,
  • Margaret MacMillan,
  • Tracy O'Brien,
  • Timothy Prestidge,
  • Akshay Sharma,
  • Peter Shaw,
  • Lena Winestone,
  • Mary Eapen

DOI
https://doi.org/10.3324/haematol.2020.249458
Journal volume & issue
Vol. 106, no. 7

Abstract

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With limited data comparing hematopoietic cell transplant outcomes between myeloablative total body irradiation (TBI) containing and non-TBI regimens in children with de novo acute myeloid leukemia, the aim of this study was to compare transplant-outcomes between these regimens. Cox regression models were used to compare transplant-outcomes after TBI and non-TBI regimens in 624 children transplanted between 2008 and 2016. Thirty two percent (n=199) received TBI regimens whereas 68% (n=425) received non-TBI regimens. Five-year non-relapse mortality was higher with TBI regimens (22% vs. 11%, p<0.0001) but relapse was lower (23% vs. 37%, p<0.0001) compared to non-TBI regimens. Consequently, overall (62% vs. 60%, p=1.00) and leukemia-free survival (55% vs. 52%, p=0.42) did not differ between treatment groups. Grade II-IV acute GVHD was higher with TBI regimens (56% vs. 27%, p<0.0001) but not chronic GVHD. The 3-year incidence of gonadal or growth hormone deficiency was higher with TBI regimens (24% vs. 8%, p<0.001) but there were no differences in late pulmonary, cardiac or renal impairment. In the absence of a survival advantage, the choice of TBI or non-TBI regimen merits careful consideration with the data favoring non-TBI regimens to limit the burden of morbidity associated with endocrine dysfunction.