Normann Steiner, Radwan Massoud, Johanna Richter, Tetiana Perekhrestenko, Nico Gagelmann, Christian Niederwieser, Kristin Rathje, Iryna Lastovytska, Mathias Schäfersküpper, Silke Heidenreich, Ina Rudolph, Gaby Zeck, Dietlinde Janson, Christine Wolschke, Francis Ayuketang Ayuk, Evgeny Klyuchnikov, Nicolaus Kröger
{"title":"在 MRD 阴性而非 MRD 阳性的急性淋巴细胞白血病首次完全缓解移植患者中，8 和 12 Gray TBI 与氟达拉滨和移植后环磷酰胺联合治疗的结果具有可比性。","authors":"Normann Steiner, Radwan Massoud, Johanna Richter, Tetiana Perekhrestenko, Nico Gagelmann, Christian Niederwieser, Kristin Rathje, Iryna Lastovytska, Mathias Schäfersküpper, Silke Heidenreich, Ina Rudolph, Gaby Zeck, Dietlinde Janson, Christine Wolschke, Francis Ayuketang Ayuk, Evgeny Klyuchnikov, Nicolaus Kröger","doi":"10.1111/ejh.14305","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The optimal TBI dose for ALL patients undergoing allogeneic SCT is still not clearly defined.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Single-center retrospective analysis of high-risk ALL patients in CR1 treated with 8 Gy (<i>n</i> = 22) or 12 Gy (<i>n</i> = 50) TBI in combination with fludarabine and PTCy. Median patient age in the 8 Gy TBI cohort was 63 (37–79) and 37 (18–56) in the 12 Gy TBI cohort and median follow-up time was 21 months (range 1–92).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>OS and LFS at 2 years after 8 Gy were 65% and 55% versus 74% and 74% after 12 Gy (<i>p</i> = 0.3 and <i>p</i> = 0.2, respectively). CIR and NRM at 2 years were 27% and 14% after 8 Gy versus 4% and 20% after 12 Gy (<i>p</i> = 0.004 and <i>p</i> = 0.4, respectively). MRD-positive (+) patients (<i>n</i> = 26) receiving 12 Gy (<i>n</i> = 19) showed better OS (<i>p</i> = 0.01), LFS (<i>p</i> = 0.009), GRFS, lower CIR (<i>p</i> = 0.02), and similar NRM than did MRD+ patients receiving 8 Gy (<i>n</i> = 7). MRD-negative (−) patients (<i>n</i> = 38) receiving 12 Gy (<i>n</i> = 27) had similar OS, LFS, GRFS, lower CIR, and higher NRM (<i>p</i> = 0.04) than did MRD− patients receiving 8 Gy (<i>n</i> = 11).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Our study demonstrates that 8 Gy TBI in comparison to 12 Gy TBI results in low NRM but a high relapse rate with similar OS, LFS, and GRFS. In MRD+ high-risk ALL patients, allogeneic SCT with 12 Gy TBI leads to improved OS, LFS, GRFS, and a low relapse rate. Prospective studies comparing the different treatment regimens with larger MRD patient cohorts are needed to confirm this data.</p>\n </section>\n </div>","PeriodicalId":11955,"journal":{"name":"European Journal of Haematology","volume":"114 1","pages":"79-88"},"PeriodicalIF":2.3000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ejh.14305","citationCount":"0","resultStr":"{\"title\":\"Comparable Results Between 8 and 12 Gray TBI in Combination With Fludarabine and Post-Transplant Cyclophosphamide in MRD-Negative but Not in MRD-Positive Acute Lymphoblastic Leukemia Patients Transplanted in First Complete Remission\",\"authors\":\"Normann Steiner, Radwan Massoud, Johanna Richter, Tetiana Perekhrestenko, Nico Gagelmann, Christian Niederwieser, Kristin Rathje, Iryna Lastovytska, Mathias Schäfersküpper, Silke Heidenreich, Ina Rudolph, Gaby Zeck, Dietlinde Janson, Christine Wolschke, Francis Ayuketang Ayuk, Evgeny Klyuchnikov, Nicolaus Kröger\",\"doi\":\"10.1111/ejh.14305\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>The optimal TBI dose for ALL patients undergoing allogeneic SCT is still not clearly defined.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Single-center retrospective analysis of high-risk ALL patients in CR1 treated with 8 Gy (<i>n</i> = 22) or 12 Gy (<i>n</i> = 50) TBI in combination with fludarabine and PTCy. Median patient age in the 8 Gy TBI cohort was 63 (37–79) and 37 (18–56) in the 12 Gy TBI cohort and median follow-up time was 21 months (range 1–92).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>OS and LFS at 2 years after 8 Gy were 65% and 55% versus 74% and 74% after 12 Gy (<i>p</i> = 0.3 and <i>p</i> = 0.2, respectively). CIR and NRM at 2 years were 27% and 14% after 8 Gy versus 4% and 20% after 12 Gy (<i>p</i> = 0.004 and <i>p</i> = 0.4, respectively). MRD-positive (+) patients (<i>n</i> = 26) receiving 12 Gy (<i>n</i> = 19) showed better OS (<i>p</i> = 0.01), LFS (<i>p</i> = 0.009), GRFS, lower CIR (<i>p</i> = 0.02), and similar NRM than did MRD+ patients receiving 8 Gy (<i>n</i> = 7). MRD-negative (−) patients (<i>n</i> = 38) receiving 12 Gy (<i>n</i> = 27) had similar OS, LFS, GRFS, lower CIR, and higher NRM (<i>p</i> = 0.04) than did MRD− patients receiving 8 Gy (<i>n</i> = 11).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Our study demonstrates that 8 Gy TBI in comparison to 12 Gy TBI results in low NRM but a high relapse rate with similar OS, LFS, and GRFS. In MRD+ high-risk ALL patients, allogeneic SCT with 12 Gy TBI leads to improved OS, LFS, GRFS, and a low relapse rate. Prospective studies comparing the different treatment regimens with larger MRD patient cohorts are needed to confirm this data.</p>\\n </section>\\n </div>\",\"PeriodicalId\":11955,\"journal\":{\"name\":\"European Journal of Haematology\",\"volume\":\"114 1\",\"pages\":\"79-88\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ejh.14305\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Haematology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/ejh.14305\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Haematology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ejh.14305","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Comparable Results Between 8 and 12 Gray TBI in Combination With Fludarabine and Post-Transplant Cyclophosphamide in MRD-Negative but Not in MRD-Positive Acute Lymphoblastic Leukemia Patients Transplanted in First Complete Remission
Background
The optimal TBI dose for ALL patients undergoing allogeneic SCT is still not clearly defined.
Methods
Single-center retrospective analysis of high-risk ALL patients in CR1 treated with 8 Gy (n = 22) or 12 Gy (n = 50) TBI in combination with fludarabine and PTCy. Median patient age in the 8 Gy TBI cohort was 63 (37–79) and 37 (18–56) in the 12 Gy TBI cohort and median follow-up time was 21 months (range 1–92).
Results
OS and LFS at 2 years after 8 Gy were 65% and 55% versus 74% and 74% after 12 Gy (p = 0.3 and p = 0.2, respectively). CIR and NRM at 2 years were 27% and 14% after 8 Gy versus 4% and 20% after 12 Gy (p = 0.004 and p = 0.4, respectively). MRD-positive (+) patients (n = 26) receiving 12 Gy (n = 19) showed better OS (p = 0.01), LFS (p = 0.009), GRFS, lower CIR (p = 0.02), and similar NRM than did MRD+ patients receiving 8 Gy (n = 7). MRD-negative (−) patients (n = 38) receiving 12 Gy (n = 27) had similar OS, LFS, GRFS, lower CIR, and higher NRM (p = 0.04) than did MRD− patients receiving 8 Gy (n = 11).
Conclusion
Our study demonstrates that 8 Gy TBI in comparison to 12 Gy TBI results in low NRM but a high relapse rate with similar OS, LFS, and GRFS. In MRD+ high-risk ALL patients, allogeneic SCT with 12 Gy TBI leads to improved OS, LFS, GRFS, and a low relapse rate. Prospective studies comparing the different treatment regimens with larger MRD patient cohorts are needed to confirm this data.
期刊介绍：
European Journal of Haematology is an international journal for communication of basic and clinical research in haematology. The journal welcomes manuscripts on molecular, cellular and clinical research on diseases of the blood, vascular and lymphatic tissue, and on basic molecular and cellular research related to normal development and function of the blood, vascular and lymphatic tissue. The journal also welcomes reviews on clinical haematology and basic research, case reports, and clinical pictures.
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