Clinical significance of low-dose total body irradiation in HLA-mismatched reduced-intensity stem cell transplantation.
Shin-Ichiro FujiwaraJunya KandaRaine TataraHiroyasu OgawaTakahiro FukudaHirokazu OkumuraKazuteru OhashiKoji IwatoYasunori UedaKen IshiyamaTetsuya EtoKen-Ichi MatsuokaHirohisa NakamaeMakoto OnizukaYoshiko AtsutaYoshinobu Kandanull nullPublished in: Bone marrow transplantation (2019)
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.
Keyphrases
- low dose
- traumatic brain injury
- high dose
- severe traumatic brain injury
- stem cell transplantation
- mild traumatic brain injury
- prognostic factors
- end stage renal disease
- newly diagnosed
- ejection fraction
- chronic kidney disease
- peritoneal dialysis
- radiation therapy
- type diabetes
- patient reported outcomes
- respiratory failure
- bone marrow
- radiation induced
- mesenchymal stem cells
- mechanical ventilation
- high intensity