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Total body irradiation (18 Gy) without chemotherapy as conditioning for allogeneic hematopoietic cell transplantation in refractory acute myeloid leukemia

Bone Marrow Transplantation volume 55, pages 1454–1456 (2020)Cite this article

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Outcomes of patients with refractory acute myeloid leukemia (rAML) are poor [1, 2]. Dose-intensification of total body irradiation (TBI), reaching doses of 20 Gy, with or without chemotherapy (CT), prior to allogeneic hematopoietic cell transplantation (alloHCT) have been explored in the hematologic malignancies [3,4,5,6,7]. Herein, we report the results of a prospective phase II trial of TBI-18Gy, without CT, as conditioning prior to alloHCT for patients with rAML [NCT01709396].

Fourteen patients with rAML 18–60 years of age, ECOG <3, with a matched related or a well- or partially-matched unrelated donor underwent transplantation between January 2012 and September 2015 with data extracted until December 2016, after informed consent was obtained. Although 20 patients were planned to be enrolled, the study was stopped early, due to the high relapse rate and the limited knowledge that would be gained with further enrollment. Exclusions included previous alloHCT or radiation therapy; uncontrolled infection; prior nephrectomy or known history of a single kidney; HIV; recent history of alcohol or drug abuse; pregnancy or absence of a donor, as described above. The primary outcome was treatment related mortality (TRM), at 1-year post alloHCT. Secondary outcomes included progression free and overall survival at 1-year post alloHCT, time to engraftment of platelets and neutrophils, the incidence of acute and chronic graft vs host disease (aGVHD and cGVHD), the relapse rate and the adverse events within the first 30 days, as assessed by recording the maximum grade according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE, version 4.0). The protocol was approved by the Ottawa Health Science Network Research Ethics Board.

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Funding

This work was funded, in part, by the Department of Medicine, University of Ottawa.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Sultan Altouri, David Allan, Harold Atkins, Jill Fulcher, Lothar Huebsch, Natasha Kekre, Christopher Bredeson & Mitchell Sabloff

  2. Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Sultan Altouri, David Allan, Harold Atkins, Jill Fulcher, Lothar Huebsch, Natasha Kekre, Christopher Bredeson & Mitchell Sabloff

  3. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Dawn Maze

  4. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Tim Ramsay

  5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Tim Ramsay

  6. Department of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada

    Rajiv Samant

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  1. Sultan Altouri
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Correspondence to Mitchell Sabloff.

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Altouri, S., Allan, D., Atkins, H. et al. Total body irradiation (18 Gy) without chemotherapy as conditioning for allogeneic hematopoietic cell transplantation in refractory acute myeloid leukemia. Bone Marrow Transplant 55, 1454–1456 (2020). https://doi.org/10.1038/s41409-020-0799-3

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