Prognostic Impact of the Fractionation of Total Body Irradiation for Patients with Acute Myeloid Leukemia Undergoing Myeloablative Allogeneic Hematopoietic Cell Transplantation

Norihiro Ueda, Takaaki Konuma, Jun Aoki, Satoshi Takahashi, Yukiyasu Ozawa, Takehiko Mori, Shuichi Ota, Tetsuya Eto, Satoru Takada, Satoshi Yoshioka, Souichi Shiratori, Shinichi Kako, Makoto Onizuka, Takahiro Fukuda, Yoshinobu Kanda, Yoshiko Atsuta, Masamitsu Yanada

Research output: Contribution to journalArticlepeer-review

Abstract

Fractionated total body irradiation (TBI) at a total dose of 12 Gy is widely used for patients with acute myeloid leukemia (AML) undergoing allogeneic hematopoietic cell transplantation (HCT); however, there is limited information regarding the optimal number of fractions. To address this issue, Japanese nationwide transplantation registry data were analyzed. Because it was found that TBI was delivered almost exclusively in 4 (n = 1215, 30%) or 6 fractions (n = 2697, 67%), we focused on comparing 4- versus 6-fraction TBI. Compared to 6-fraction TBI, the 4-fraction version was associated with reduced risk of overall mortality (P = .002) and relapse (P = .018), while there was no difference in the risk of nonrelapse mortality (P = .422). The 4-fraction version did not aggravate acute graft-versus-host disease (GVHD), interstitial pneumonia, or sinusoidal obstruction syndrome of the liver. Chronic GVHD developed more frequently with the use of 4-fraction TBI, although the incidence of extensive chronic GVHD was similar. Subgroup analyses revealed that the 4-fraction version provided benefits for patients in non-complete remission (non-CR) but not for those in CR at transplantation. These findings suggest the advantage of 4-fraction over 6-fraction TBI for patients with AML undergoing allogeneic HCT in non-CR.

Original languageEnglish
Pages (from-to)185.e1-185.e6
JournalTransplantation and Cellular Therapy
Volume27
Issue number2
DOIs
Publication statusPublished - 2021 Feb

Keywords

  • Acute myeloid leukemia
  • Allogeneic hematopoietic cell transplantation
  • Fractionation
  • Total body irradiation

ASJC Scopus subject areas

  • Hematology
  • Transplantation
  • Immunology and Allergy
  • Cell Biology
  • Molecular Medicine

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