A Ocanto1, A Escribano2, L Glaría2, I Rodríguez2, C Ferrer3, C Huertas3, A Pérez4, R Morera2. 1. Radiation Oncology Department, Hospital Universitario La Paz, Pº de La Castellana, 261, Madrid, 28046, Spain. abraham.ocanto@gmail.com. 2. Radiation Oncology Department, Hospital Universitario La Paz, Pº de La Castellana, 261, Madrid, 28046, Spain. 3. Radiophysics and Radioprotection Department, Hospital Universitario La Paz, Pº de La Castellana, 261, Madrid, 28046, Spain. 4. Pediatric Hematology-Oncology Department, Hospital Universitario La Paz, Pº de La Castellana, 261, 28046, Madrid, Spain.
Abstract
PURPOSE: Hematopoietic progenitor cell transplantation (HSCT) is a procedure used in different hematological diseases as part of the curative treatment, so the investigators propose a system of conditioning of reduced intensity based on total lymphoid irradiation (TLI) as an alternative to the classic total body irradiation (TBI) followed by haploidentical transplantation in patients compatible with a single HLA haplotype, as an alternative to patients who do not have an HLA compatible donor. MATERIALS AND METHODS: A cohort of 25 patients with hematological disease underwent haploidentical HSCT from February 2015 to May 2018, conditioned with TLI from day - 10 (2-4 days of treatment) followed by thiotepa (5 mg/kg/12 h) and melphalan (70 mg/m2/day) prior to HSCT and prophylaxis with ciclosporin (1.5 mg/kg/12 h). 2 Gy/fraction was administered to complete 8 Gy with IMRT and VMAT technique. RESULTS: 12% rejection of the transplant was obtained with acute GVHD < II (48%) and chronic GVHD 12%. No acute toxicity was recorded in irradiated patients and 56% survival of patients at the end of follow-up. CONCLUSION: Conditioning the haploidentical transplant with TLI, IMRT, and VMAT techniques compared with TBI and RT3D-C techniques is a feasible technique that helps inducing the necessary immunosuppression in patients with a high risk of graft rejection, minimal adverse effects, low incidence of GVHD, and high survival rate.
PURPOSE: Hematopoietic progenitor cell transplantation (HSCT) is a procedure used in different hematological diseases as part of the curative treatment, so the investigators propose a system of conditioning of reduced intensity based on total lymphoid irradiation (TLI) as an alternative to the classic total body irradiation (TBI) followed by haploidentical transplantation in patients compatible with a single HLA haplotype, as an alternative to patients who do not have an HLA compatible donor. MATERIALS AND METHODS: A cohort of 25 patients with hematological disease underwent haploidentical HSCT from February 2015 to May 2018, conditioned with TLI from day - 10 (2-4 days of treatment) followed by thiotepa (5 mg/kg/12 h) and melphalan (70 mg/m2/day) prior to HSCT and prophylaxis with ciclosporin (1.5 mg/kg/12 h). 2 Gy/fraction was administered to complete 8 Gy with IMRT and VMAT technique. RESULTS: 12% rejection of the transplant was obtained with acute GVHD < II (48%) and chronic GVHD 12%. No acute toxicity was recorded in irradiated patients and 56% survival of patients at the end of follow-up. CONCLUSION: Conditioning the haploidentical transplant with TLI, IMRT, and VMAT techniques compared with TBI and RT3D-C techniques is a feasible technique that helps inducing the necessary immunosuppression in patients with a high risk of graft rejection, minimal adverse effects, low incidence of GVHD, and high survival rate.
Entities:
Keywords:
Haploidentic; Pediatrics; TLI; Total lymphoid irradiation oncology
Authors: Elizabeth H Phillips; Stephen Devereux; John Radford; Naheed Mir; Toyin Adedayo; Laura Clifton-Hadley; Rod Johnson Journal: Leuk Lymphoma Date: 2019-02-18
Authors: Jeffrey Y C Wong; An Liu; Timothy Schultheiss; Leslie Popplewell; Anthony Stein; Joseph Rosenthal; Mark Essensten; Stephen Forman; George Somlo Journal: Biol Blood Marrow Transplant Date: 2006-03 Impact factor: 5.742
Authors: Luisa Sisinni; Mercedes Gasior; Raquel de Paz; Sergio Querol; David Bueno; Lucia Fernández; Julia Marsal; Ana Sastre; Ramon Gimeno; Laura Alonso; Isabel Badell; Eduardo López-Granados; Juan Torres; Laura Medina; Montserrat Torrent; Cristina Diaz de Heredia; Adela Escudero; Antonio Pérez-Martínez Journal: Biol Blood Marrow Transplant Date: 2018-07-19 Impact factor: 5.742
Authors: Jean M Mulcahy Levy; Tiffany Tello; Roger Giller; Greta Wilkening; Ralph Quinones; Amy K Keating; Arthur K Liu Journal: Pediatr Blood Cancer Date: 2012-07-27 Impact factor: 3.167
Authors: Christina Peters; Michael H Albert; Anna Eichinger; Ulrike Poetschger; Evgenia Glogova; Peter Bader; Oliver Basu; Rita Beier; Birgit Burkhardt; Carl-Friedrich Classen; Alexander Claviez; Selim Corbacioglu; Hedwig E Deubzer; Johann Greil; Bernd Gruhn; Tayfun Güngör; Kinan Kafa; Jörn-Sven Kühl; Peter Lang; Bjoern Soenke Lange; Roland Meisel; Ingo Müller; Martin G Sauer; Paul-Gerhardt Schlegel; Ansgar Schulz; Daniel Stachel; Brigitte Strahm; Angela Wawer Journal: Leukemia Date: 2022-09-12 Impact factor: 12.883
Authors: D Wegener; P Lang; F Paulsen; N Weidner; D Zips; M Ebinger; U Holzer; M Döring; F Heinzelmann Journal: Strahlenther Onkol Date: 2021-09-02 Impact factor: 3.621