Comparable Results Between 8 and 12 Gray TBI in Combination With Fludarabine and Post-Transplant Cyclophosphamide in MRD-Negative but Not in MRD-Positive Acute Lymphoblastic Leukemia Patients Transplanted in First Complete Remission.

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS

ACS Applied Bio Materials Pub Date : 2024-09-19 DOI:10.1111/ejh.14305

Normann Steiner, Radwan Massoud, Johanna Richter, Tetiana Perekhrestenko, Nico Gagelmann, Christian Niederwieser, Kristin Rathje, Iryna Lastovytska, Mathias Schäfersküpper, Silke Heidenreich, Ina Rudolph, Gaby Zeck, Dietlinde Janson, Christine Wolschke, Francis Ayuketang Ayuk, Evgeny Klyuchnikov, Nicolaus Kröger

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引用次数: 0

Abstract

Background: The optimal TBI dose for ALL patients undergoing allogeneic SCT is still not clearly defined.

Methods: Single-center retrospective analysis of high-risk ALL patients in CR1 treated with 8 Gy (n = 22) or 12 Gy (n = 50) TBI in combination with fludarabine and PTCy. Median patient age in the 8 Gy TBI cohort was 63 (37-79) and 37 (18-56) in the 12 Gy TBI cohort and median follow-up time was 21 months (range 1-92).

Results: OS and LFS at 2 years after 8 Gy were 65% and 55% versus 74% and 74% after 12 Gy (p = 0.3 and p = 0.2, respectively). CIR and NRM at 2 years were 27% and 14% after 8 Gy versus 4% and 20% after 12 Gy (p = 0.004 and p = 0.4, respectively). MRD-positive (+) patients (n = 26) receiving 12 Gy (n = 19) showed better OS (p = 0.01), LFS (p = 0.009), GRFS, lower CIR (p = 0.02), and similar NRM than did MRD+ patients receiving 8 Gy (n = 7). MRD-negative (-) patients (n = 38) receiving 12 Gy (n = 27) had similar OS, LFS, GRFS, lower CIR, and higher NRM (p = 0.04) than did MRD- patients receiving 8 Gy (n = 11).

Conclusion: Our study demonstrates that 8 Gy TBI in comparison to 12 Gy TBI results in low NRM but a high relapse rate with similar OS, LFS, and GRFS. In MRD+ high-risk ALL patients, allogeneic SCT with 12 Gy TBI leads to improved OS, LFS, GRFS, and a low relapse rate. Prospective studies comparing the different treatment regimens with larger MRD patient cohorts are needed to confirm this data.

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在 MRD 阴性而非 MRD 阳性的急性淋巴细胞白血病首次完全缓解移植患者中，8 和 12 Gray TBI 与氟达拉滨和移植后环磷酰胺联合治疗的结果具有可比性。

背景：接受异基因 SCT 的 ALL 患者的最佳 TBI 剂量仍未明确定义：单中心回顾性分析 CR1 期高风险 ALL 患者，采用 8 Gy（n = 22）或 12 Gy（n = 50）TBI 联合氟达拉滨和 PTCy 治疗。8 Gy TBI组患者的中位年龄为63岁（37-79岁），12 Gy TBI组患者的中位年龄为37岁（18-56岁），中位随访时间为21个月（1-92个月）：结果：8 Gy治疗后2年的OS和LFS分别为65%和55%，而12 Gy治疗后分别为74%和74%（P = 0.3和P = 0.2）。8Gy治疗后2年的CIR和NRM分别为27%和14%，而12Gy治疗后分别为4%和20%（P = 0.004和P = 0.4）。与接受 8 Gy 治疗的 MRD+ 患者（n = 7）相比，接受 12 Gy 治疗的 MRD 阳性 (+) 患者（n = 26）（n = 19）显示出更好的 OS（p = 0.01）、LFS（p = 0.009）和 GRFS，更低的 CIR（p = 0.02）和相似的 NRM。与接受 8 Gy 治疗的 MRD- 患者（n = 11）相比，接受 12 Gy 治疗的 MRD 阴性（-）患者（n = 38）（n = 27）具有相似的 OS、LFS、GRFS、较低的 CIR 和较高的 NRM（p = 0.04）：我们的研究表明，8 Gy TBI 与 12 Gy TBI 相比，NRM 低，但复发率高，OS、LFS 和 GRFS 相似。在 MRD+ 高危 ALL 患者中，使用 12 Gy TBI 进行异基因 SCT 可改善 OS、LFS 和 GRFS，并降低复发率。要证实这些数据，还需要在更大的MRD患者队列中对不同治疗方案进行比较的前瞻性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Bio Materials Chemistry-Chemistry (all)

CiteScore

9.40

自引率

2.10%

发文量

464