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
Affiliations
Christopher E. Dandoy
Cincinnati Children Hospital Medical Center, Cincinnati, OH, USA;
Stella M. Davies
Cincinnati Children Hospital Medical Center, Cincinnati, OH, USA;
Kwang Woo Ahn
Division of Biostatics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, USA;
Yizeng He
Division of Biostatics, Institute for Heath and Equity, Medical College of Wisconsin, Milwaukee, USA;
Anders E. Kolb
Division of Hematology-Oncology, Alfred I. duPont Hospital for Children, Wilmington, USA;
John Levine
Blood and Marrow Transplant Program, Icahn School of Medicine at Mount Sinai, New York, USA;
Stephanie Bo-Subait
National Marrow Donor Program/Be The Match, Minneapolis, MN, USA;
Hisham Abdel-Azim
Children Hospital Los Angeles, University of Southern California Keck School of Medicine, USA;
Neel Bhatt
Department of Data Abstraction, Fred Hutchinson Cancer Research Center, Seattle, USA;
Joseph Chewning
Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, USA;
Shahinaz Gadalla
Division of Cancer Epidemiology & Genetics, NIH-NCI Clinical Genetics Branch, Rockville, MD, USA;
Nicholas Gloude
Division of Hematology-Oncology, Rady Children Hospital San Diego, San Diego, USA;
Robert Hayashi
Department of Pediatrics, Washington University School of Medicine in St. Louis, USA;
Nahal R. Lalefar
Division of Hematology-Oncology, Children Hospital and Research Center Oakland, CA, USA;
Jason Law
Division of Pediatric Hematology-Oncology, Tufts Medical Center, Boston, MA, USA;
Margaret MacMillan
Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA;
Tracy O'Brien
Kids Cancer Centre, Sydney Children Hospital, Sydney, Australia;
Timothy Prestidge
Blood and Cancer Centre, Starship Children Hospital, Auckland, New Zealand;
Akshay Sharma
St. Jude Children Research Hospital, Memphis, TN, USA;
Peter Shaw
The Children Hospital at Westmead; Westmead, Australia;
Lena Winestone
Department of Pediatrics, Children Hospital of Philadelphia, Philadelphia, PA, USA;
Mary Eapen
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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.
