Update on Total-Body Irradiation in Children With de Novo AML
Posted: Friday, September 25, 2020
Survival outcomes did not appear to significantly differ among children with de novo acute myeloid leukemia (AML) who received hematopoietic cell transplant regimens with or without myeloablative total-body irradiation, according to the results of a retrospective study published in Haematologica. Therefore, the choice of including total-body irradiation or not may come down to acknowledging different data: that non–total-body irradiation regimens “limit the burden of morbidity associated with endocrine dysfunction,” wrote Mary Eapen, MBBS, MS, of the Medical College of Wisconsin, Milwaukee, and colleagues.
Specifically, the 3-year incidence of gonadal or growth hormone deficiency was higher with total-body irradiation regimens (24% vs. 8%; P < .001). The researchers used Cox regression models to compare the outcomes of 624 children (21 years or younger) who received transplants between 2008 and 2016; 199 patients (32%) received total-body irradiation, and 425 patients (68%) did not. The data were taken from worldwide reports made to an observational registry, the Center for International Blood and Marrow Transplant Research.
With total-body irradiation regimens, 5-year nonrelapse mortality was higher (22% vs. 11%; P < .0001) but relapse was lower (23% vs. 37%; P < .0001) compared with non–total-body irradiation regimens. “Consequently, overall survival (62% vs. 60%; P = 1.00) and leukemia-free survival (55% vs. 52%; P = .42) did not differ between treatment groups,” noted the team. In addition, there were no differences observed between the groups in terms of late pulmonary, cardiac, or renal impairment. And although grade II to IV acute graft-versus-host disease occurred in a higher percentage of children given a total-body irradiation regimen (56% vs. 27%; P < .0001), no such difference emerged between the groups in terms of chronic graft-versus-host disease.
Disclosure: The study authors reported no conflicts of interest.