Myeloablative Hematopoietic Stem Cell Transplantation with a Non-total Body Irradiation Regimen for Treating Pediatric Acute Lymphoblastic Leukemia

다국어 초록 (Multilingual Abstract)

Background: Total body irradiation (TBI) has been traditionally used as a conditioning regimen prior to hematopoietic stem cell transplantation (HSCT) in patients with pediatric leukemia. However, TBI can cause late sequelae such as growth impairment, cataract, hormone abnormalities, infertility, neurocognitive effects, and secondary malignancy in pediatric patients.
Methods: This single center retrospective study included 22 patients with acute lymphoblastic leukemia who were aged ＜18 years and underwent HSCT between May 1999 and December 2014; seven patients received a TBI-based regimen and 15 received a non-TBI regimen.
Results: The overall survival and event-free survival rates in the TBI group were not significantly different from those in the non-TBI group (overall survival rate 71% vs. 73%, respectively; P=0.906; event-free survival rate 71% vs. 73%, respectively P=0.923).
Conclusion: Our results indicate that non-TBI conditioning regimens can be an alternative treatment option of the treatment of pediatric acute lymphoblastic leukemia undergoing HSCT.

참고문헌 (Reference)

1 김상정, "소아 백혈병 환자의 동종 조혈모세포이식 전처치로서 전신방사선 조사 포함군과 비포함군의 비교" 대한소아과학회 53 (53): 538-547, 2010

2 Tracey J, "Transplantation conditioning regimens and outcomes after allogeneic hematopoietic cell transplantation in children and adolescents with acute lymphoblastic leukemia" 19 : 255-259, 2013

3 Chessells JM, "The management of high-risk lymphoblastic leukaemia in children" 108 : 204-216, 2000

4 Sanders JE, "The impact of marrow transplant preparative regimens on subsequent growth and development. The Seattle Marrow Transplant Team" 28 : 244-249, 1991

5 Santos GW, "The development of busulfan/cyclophosphamide preparative regimens" 20 (20): 12-16, 1993

6 Mori T, "Safety and efficacy of total body irradiation, cyclophosphamide, and cytarabine as a conditioning regimen for allogeneic hematopoietic stem cell transplantation in patients with acute lymphoblastic leukemia" 87 : 349-353, 2012

7 Bunin N, "Randomized trial of busulfan vs total body irradiation containing conditioning regimens for children with acute lymphoblastic leukemia: a Pediatric Blood and Marrow Transplant Consortium study" 32 : 543-548, 2003

8 Santos GW, "Marrow transplantation in the busulfan-treated rat: preclinical model of aplastic anemia" 53 : 1781-1785, 1974

9 Bhatia S, "Malignant neoplasms following bone marrow transplantation" 87 : 3633-3639, 1996

10 Gaynon PS, "Long-term results of the children's cancer group studies for childhood acute lymphoblastic leukemia 1983-2002: a Children's Oncology Group Report" 24 : 285-297, 2010

11 Locatelli F, "Late effects in children after bone marrow transplantation: a review" 78 : 319-328, 1993

12 Granados E, "Hematopoietic cell transplantation in acute lymphoblastic leukemia: better long term event-free survival with conditioning regimens containing total body irradiation" 85 : 1060-1067, 2000

13 Cohen A, "Growth in patients after allogeneic bone marrow transplant for hematological diseases in childhood" 15 : 343-348, 1995

14 Shankar SM, "Growth in children undergoing bone marrow transplantation after busulfan and cyclophosphamide conditioning" 18 : 362-366, 1996

15 Sanders JE, "Growth and development after hematopoietic cell transplant in children" 41 : 223-227, 2008

16 Legault L, "Endocrine complications of bone marrow transplantation in children" 3 : 60-66, 1999

17 Jongmoo Park, "Effects of total body irradiation-based conditioning on allogeneic stem cell transplantation for pediatric acute leukemia: a single-institution study" 대한방사선종양학회 32 (32): 198-207, 2014

18 Davies SM, "Comparison of preparative regimens in transplants for children with acute lymphoblastic leukemia" 18 : 340-347, 2000

19 Shulman HM, "Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients" 69 : 204-217, 1980

20 Ciurea SO, "Busulfan in hematopoietic stem cell transplantation" 15 : 523-536, 2009

21 Thomas ED, "Bone marrow transplantation in hematologic malignancies" 22 : 77-91, 1987

22 Wolden SL, "American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) practice guideline for the performance of total body irradiation (TBI)" 36 : 97-101, 2013

23 Hunger SP, "Acute lymphoblastic leukemia in children" 373 : 1541-1552, 2015

24 Ringdén O, "A randomized trial comparing busulfan with total body irradiation as conditioning in allogeneic marrow transplant recipients with leukemia: a report from the Nordic Bone Marrow Transplantation Group" 83 : 2723-2730, 1994

25 Przepiorka D, "1994 Consensus Conference on Acute GVHD Grading" 15 : 825-828, 1995