International Journal of Hematology and Oncology
2025, Vol 35, Num 3 Page(s): 166-171
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Total Body Irradiation as a Component of Conditioning Regimen in Allogeneic Hematopoietic Stem Cell Transplantation for Pediatric ALL
Serra KAMER1, Cagri HIDIMOGLU1, Sinan HOCA2, Serap AKSOYLAR3, Gulcihan OZEK3, Yavuz ANACAK1
1Ege University Faculty of Medicine, Department of Radiation Oncology
2Ege University Medical Physics, Department of Radiation Oncology
3Ege University Faculty of Medicine, Department of Pediatric Hematology and Oncology
Keywords: Total body irradiation, Pediatric ALL,Side Effects, Stem cell transplantation
The use of Total Body Irradiation (TBI) as part of allogeneic hematopoietic stem cell transplantation has shown promising results in reducing the risk of relapse in children with Acute Lymphoblastic Leukemia (ALL) without increasing the incidence of transplant-related mortality. This study aims to evaluate the outcomes and toxicity of TBI in combination with etoposide for allogeneic hematopoietic stem cell transplantation in pediatric ALL patients. The patient data from Ege University Hospital was used for this study. The following is a retrospective evaluation of 91 patients who underwent TBI in the allogenic transplant protocol with a diagnosis of ALL between January 2009 and December 2022. The patients received treatment according to two different protocols- the BFM 2003 protocol (19 cases) between 2009 and 2012 and the BFM 2012 protocol (62 cases) after 2012. Total body irradiation was administered in 6 fractions twice a day, totaling 12 Gy. The median age at diagnosis was 8 years (range: 1-17), and at the time of TBI application 10 years (range: 3-18). Sibling donors were used in 61 cases (67%), while 30 cases (33%) received transplants from unrelated donors. For 14 patients with central nervous system involvement at diagnosis or relapse, an additional 6 Gy cranial boost dose was administered according to the protocol. After a median follow-up of 56 months (range: 1-145), recurrence was observed in 9 cases (8.8%). Disease recurrence resulted in the loss of 9 cases, and 12 cases (13.2%) were lost due to treatment-related complications. Recurrence sites were identified as bone marrow in 6 cases and central nervous system in 3 cases. The 4-year overall survival rate was determined as 76.9. Four-year survival rate of 18.3% was observed in related donor transplantation, whereas it was 32.3% in unrelated donor transplantation (p< 0.01). Acute side effects related to total body irradiation of grade 2-3 were observed in 37 cases (41.7%). The most common acute side effects were nausea in 21 cases, parotitis in 11 cases, and headache in 3 cases. Late-onset side effects were observed in 47 cases. TBI related side effects was reported as sexual dysfunction in 3 cases, hypothyroidism in 6 cases, cataract in 3 cases, osteoporosis in 1 case, and veno-occlusive disease in 4 cases. Also, soft tissue sarcoma was diagnosed in 1 case 79 months after treatment. Transplant-associated Graft Versus Host Disease (GVHD) was observed in 13 cases (12.1%). Studies have shown that including total body irradiation (TBI) in the conditioning regimen for patients undergoing allogeneic transplantation is a reliable and effective protocol with favorable side effect profiles. For long-term outcomes, a more comprehensive multidisciplinary follow-up is recommended.
Serra KAMER1, Cagri HIDIMOGLU1, Sinan HOCA2, Serap AKSOYLAR3, Gulcihan OZEK3, Yavuz ANACAK1
1Ege University Faculty of Medicine, Department of Radiation Oncology
2Ege University Medical Physics, Department of Radiation Oncology
3Ege University Faculty of Medicine, Department of Pediatric Hematology and Oncology
Keywords: Total body irradiation, Pediatric ALL,Side Effects, Stem cell transplantation
The use of Total Body Irradiation (TBI) as part of allogeneic hematopoietic stem cell transplantation has shown promising results in reducing the risk of relapse in children with Acute Lymphoblastic Leukemia (ALL) without increasing the incidence of transplant-related mortality. This study aims to evaluate the outcomes and toxicity of TBI in combination with etoposide for allogeneic hematopoietic stem cell transplantation in pediatric ALL patients. The patient data from Ege University Hospital was used for this study. The following is a retrospective evaluation of 91 patients who underwent TBI in the allogenic transplant protocol with a diagnosis of ALL between January 2009 and December 2022. The patients received treatment according to two different protocols- the BFM 2003 protocol (19 cases) between 2009 and 2012 and the BFM 2012 protocol (62 cases) after 2012. Total body irradiation was administered in 6 fractions twice a day, totaling 12 Gy. The median age at diagnosis was 8 years (range: 1-17), and at the time of TBI application 10 years (range: 3-18). Sibling donors were used in 61 cases (67%), while 30 cases (33%) received transplants from unrelated donors. For 14 patients with central nervous system involvement at diagnosis or relapse, an additional 6 Gy cranial boost dose was administered according to the protocol. After a median follow-up of 56 months (range: 1-145), recurrence was observed in 9 cases (8.8%). Disease recurrence resulted in the loss of 9 cases, and 12 cases (13.2%) were lost due to treatment-related complications. Recurrence sites were identified as bone marrow in 6 cases and central nervous system in 3 cases. The 4-year overall survival rate was determined as 76.9. Four-year survival rate of 18.3% was observed in related donor transplantation, whereas it was 32.3% in unrelated donor transplantation (p< 0.01). Acute side effects related to total body irradiation of grade 2-3 were observed in 37 cases (41.7%). The most common acute side effects were nausea in 21 cases, parotitis in 11 cases, and headache in 3 cases. Late-onset side effects were observed in 47 cases. TBI related side effects was reported as sexual dysfunction in 3 cases, hypothyroidism in 6 cases, cataract in 3 cases, osteoporosis in 1 case, and veno-occlusive disease in 4 cases. Also, soft tissue sarcoma was diagnosed in 1 case 79 months after treatment. Transplant-associated Graft Versus Host Disease (GVHD) was observed in 13 cases (12.1%). Studies have shown that including total body irradiation (TBI) in the conditioning regimen for patients undergoing allogeneic transplantation is a reliable and effective protocol with favorable side effect profiles. For long-term outcomes, a more comprehensive multidisciplinary follow-up is recommended.
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