First experience of total body irradiation in conditioning regimes for allogenic hematopoietic stem cells transplantation in children with acute lymphoblastic leukemia in Saint Petersburg

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Abstract

Background. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective treatment method of refractory and recurrent forms of acute leukemia in children, while the question of choosing a conditioning regimen in order to achieve the best treatment results remains debatable. Conditioning based on total body irradiation (TbI) was confirmed to be most effective in some trials, but there are still issues of overcoming early and late toxicity, as well   as difficulties in planning and routing patients.
Aim. To share the experience of interdisciplinary patient management during the conditioning period with TbI inclusion in Saint petersburg, to evaluate the feasibility, toxicity and effectiveness of the method.
Materials and methods. patients undergoing allo-HSCT for high risk acute lymphoblastic leukemia conditioned either with TbI (n = 12) or chemotherapy (n = 10) were included. Medical data were retrospectively analyzed with an assessment of the following transplant outcomes: HSCT-associated toxicity, the frequency and severity of infectious complications, graft versus host disease, as well as overall and event-free survival rates. we have evaluated radiotherapy plans in order to assess the compliance of radiation exposure with acceptable values for critical organs.
Results. All patients with acute lymphoblastic leukemia in both groups received appropriate myeloablative conditioning. According to the study results, despite the lack of significance, we obtained differences in HSCT-associated mortality (8.3 and 30 %; p = 0.151), 2-years overall and event-free survival (66 ± 13.6 and 36 ± 16.1 %; p = 0.122) in group with TbI and HdCT respectively. It should be noted that there was a trend towards a decrease of toxic reactions frequency in case of TbI-containing regimens; however we didn’t reveal any significant differences in the number of infectious complications during post-transplant period. The median follow-up was 24.2 months and there were no signs of delayed toxicity.
Conclusion. TbI-based conditioning was well tolerated with a low incidence of early and delayed toxicity, better overall and event-free survival. based on feasibility of TbI in Saint petersburg hospitals it is possible to recommend the method in routine practice, taking into account clinical indications.

About the authors

Yu. V. Dinikina

V.A. Almazov National Medical Research Centre, Ministry of Health of Russia

Author for correspondence.
Email: dinikina_yuv@almazovcentre.ru
ORCID iD: 0000-0002-2003-0982

8 Akkuratova St., Saint Petersburg 197341

Russian Federation

A. V. Mikhailov

Diagnostic and Treatment Center, International Institute of Biological Systems named after Sergey Berezin; I.I. Mechnikov North-West State Medical University, Ministry of Health of Russia

ORCID iD: 0000-0002-5240-7203

Build. 3a, 2 Esenina St., Saint Petersburg 194354

41 Kirochnaya St., Saint Petersburg 191015

Russian Federation

M. A. Rusina

V.A. Almazov National Medical Research Centre, Ministry of Health of Russia

ORCID iD: 0000-0001-5577-8950

8 Akkuratova St., Saint Petersburg 197341

Russian Federation

A. Yu. Smirnova

V.A. Almazov National Medical Research Centre, Ministry of Health of Russia

ORCID iD: 0000-0002-5293-9568

8 Akkuratova St., Saint Petersburg 197341

Russian Federation

N. A. Vorob’ov

Diagnostic and Treatment Center, International Institute of Biological Systems named after Sergey Berezin; Saint Petersburg State University

ORCID iD: 0000-0002-6998-5771

Build. 3a, 2 Esenina St., Saint Petersburg 194354

7–9 Universitetskaya Naberezhnaya, Saint Petersburg 199034

Russian Federation

N. A. Kataev

Diagnostic and Treatment Center, International Institute of Biological Systems named after Sergey Berezin

ORCID iD: 0000-0003-2757-2802

Build. 3a, 2 Esenina St., Saint Petersburg 194354

Russian Federation

A. V. Kubasov

Diagnostic and Treatment Center, International Institute of Biological Systems named after Sergey Berezin

ORCID iD: 0000-0001-7672-6703

Build. 3a, 2 Esenina St., Saint Petersburg 194354

Russian Federation

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