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Clinical significance of low-dose total body irradiation in HLA-mismatched reduced-intensity stem cell transplantation

Bone Marrow Transplantation volume 54, pages 1327–1336 (2019)Cite this article

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Abstract

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.

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Acknowledgments

The authors thank all physicians at the centers who contributed valuable data on transplantation to the JSHCT and Japan Marrow Donor Program (JMDP). The authors also thank all the members of the data management committees of JSHCT and JMDP for their assistance.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan

    Shin-ichiro Fujiwara & Yoshinobu Kanda

  2. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Junya Kanda

  3. Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Sunto, Japan

    Raine Tatara

  4. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan

    Hiroyasu Ogawa

  5. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  6. Department of Internal Medicine (Hematology), Toyama Prefectural Central Hospital, Toyama, Japan

    Hirokazu Okumura

  7. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Kazuteru Ohashi

  8. Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan

    Koji Iwato

  9. Department of Hematology/Oncology and Transfusion and Hemapheresis Center, Kurashiki Central Hospital, Kurashiki, Japan

    Yasunori Ueda

  10. Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan

    Ken Ishiyama

  11. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  12. Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan

    Ken-ichi Matsuoka

  13. Hematology, Osaka City University Hospital, Osaka, Japan

    Hirohisa Nakamae

  14. Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan

    Makoto Onizuka

  15. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  16. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    Yoshinobu Kanda

Authors
  1. Shin-ichiro Fujiwara
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  2. Junya Kanda
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  3. Raine Tatara
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  4. Hiroyasu Ogawa
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  5. Takahiro Fukuda
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  7. Kazuteru Ohashi
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  8. Koji Iwato
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  9. Yasunori Ueda
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  10. Ken Ishiyama
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  11. Tetsuya Eto
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  12. Ken-ichi Matsuoka
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  13. Hirohisa Nakamae
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  14. Makoto Onizuka
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  15. Yoshiko Atsuta
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  16. Yoshinobu Kanda
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on behalf of the HLA Working Group of the Japan Society for Hematopoietic Cell Transplantation

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Correspondence to Yoshinobu Kanda.

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Fujiwara, Si., Kanda, J., Tatara, R. et al. Clinical significance of low-dose total body irradiation in HLA-mismatched reduced-intensity stem cell transplantation. Bone Marrow Transplant 54, 1327–1336 (2019). https://doi.org/10.1038/s41409-019-0434-3

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  • DOI: https://doi.org/10.1038/s41409-019-0434-3

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