Abstract
The aim of this study was to determine whether parameters related to TBI impacted upon OS and relapse in patients with acute leukemia in CR who underwent haematopoietic SCT (HSCT) in 11 Italian Radiation Oncology Centres. Data were analysed from 507 patients (313 males; 194 females; median age 15 years; 318 with ALL; 188 with AML; 1 case not recorded). Besides 128 autologous transplants, donors included 192 matched siblings, 74 mismatched family members and 113 unrelated individuals. Autologous and allogeneic transplants were analysed separately. Median follow-up was 40.1 months. TBI schedules and HSCT type were closely related. Uni- and multi-variate analyses showed no parameter was significant for OS or relapse in autologous transplantation. Multivariate analysis showed type of transplant and disease impacted significantly on OS in allogeneic transplantation. Disease, GVHD and TBI dose were risk factors for relapse. This analysis illustrates that Italian Transplant Centre use of TBI is in line with international practice. Most Centres adopted a hyperfractionated schedule that is used worldwide (12 Gy in six fractions over 3 days), which appears to have become standard. TBI doses impacted significantly upon relapse rates.
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Acknowledgements
This work was partly supported by the ‘Quality Indicators for Radiotherapy’ Project, funded by the Italian Ministry of Health. The authors would like to thank Geraldine A Boyd for editing this paper. The authors would also like to thank, for having collected data, Paola Anselmo, Michele Benedetti, Massimo Berger, Francesco Borgia, Maria Samaritana Buzzaccarini, Silvia Durzu, Rita Felicini, Chiara Julita, Francesca Mascioni, Filippo Milano, Maddalena Giannini, Tindara Munafò, Dolores Tomasini, Stefania Varotto, Lisa Vicenzi, Elena Viganò, Elisabetta Vitali.
Italian TBI Working group
Cynthia Aristei: Università degli Studi e Azienda Ospedaliera - Struttura Complessa di Radioterapia Oncologica - Ospedale Santa Maria della Misericordia Perugia; Lorenzo Falcinelli: Struttura Complessa di Radioterapia Oncologica Azienda Ospedaliera Perugia; Gianni Gobbi, Carlo Raymondi: Servizio di Fisica Sanitaria; Azienda Ospedaliera, Ospedale Santa Maria della Misericordia, Perugia; Franco Aversa: Ematologia e Centro Trapianti Midollo Osseo, Università di Parma e Ospedale Maggiore, Parma; Antonella Santucci: Università degli Studi e Azienda Ospedaliera – Centro Trapianto Midollo Osseo - Santa Maria della Misericordia, Perugia
Enza Barbieri: Università di Bologna e Divisione di Radioterapia Ospedale S.Orsola Malpighi, Bologna; Andrea Ferri: Servizio di Fisica Sanitaria Ospedale S.Orsola Malpighi, Bologna; Giuseppe Bandini: Istituto di Ematologia Ospedale S.Orsola Malpighi, Bologna; Andrea Pession: Dipartimento Scienze Pediatriche, Ospedale S.Orsola Malpighi, Bologna
Stefano Maria Magrini: Istituto del Radio «O.Alberti» Università degli Studi e Spedali Civili, Brescia; Filippo Bertoni: UOC di Radioterapia Oncologica, Azienda Ospedaliero-Univeristaria Policlinico di Modena, Modena; Marco Galelli: Servizio di Fisica Sanitaria Spedali Civili, Brescia; Sandro Tonoli: Radioterapia Spedali Civili, Brescia; Michela Buglione di Monale e Bastia: Cattedra di Radioterapia, Università di Brescia
Renzo Corvò: Università degli Studi e Istituto Nazionale per la Ricerca sul Cancro, Genova; Franca Foppiano: Servizio di Fisica Sanitaria, ASL5, La Spezia; Salvina Barra: Divisione di Radioterapia Oncologica Istituto Nazionale per la Ricerca sul Cancro, Genova; Andrea Bacigalupo, Francesco Frassoni, Barbara Bruno: Centro Trapianto Midollo Osseo Ospedale San Martino, Genova; Giorgio Dini: Unità di Onco-Ematologia Pediatrica Ospedale Gaslini, Genova; Maura Faraci: Unità Trapianto Midollo Osseo Ospedale Gaslini, Genova
Gianstefano Gardani: U.O. di Radioterapia Oncologica Università di Milano «La Bicocca» e Ospedale S. Gerardo, Monza; Cornelio Uderzo: Ematologia Pediatrica Ospedale S. Gerardo, Monza; Andrea Crespi: Servizio di Fisica Sanitaria Ospedale S. Gerardo, Monza
Giovanni Scarzello: Radioterapia Azienda Ospedaliera, Padova; Roberto Zandonà: Servizio di Fisica Sanitaria Azienda Ospedaliera, Padova; Chiara Messina: Ematologia Azienda Ospedaliera, Padova
Vittorio Donato: Dipartimento di Radioterapia, Ospedale San Camillo-Forlanini, Roma; Lavinia Grapulin: Policlinico Umberto I - Radioterapia - Istituto di Radiologia Università «La Sapienza», Roma; Cinzia Di Felice, Elisabetta Di Castro: Policlinico Umberto I - Fisica Sanitaria - Istituto di Radiologia Università «La Sapienza», Roma; Anna Paola Iori: Policlinico Umberto I – Ematologia- Università «La Sapienza», Roma; Walter Barbieri: Policlinico Umberto I – Ematologia- Università «La Sapienza», Roma; William Arcese: Dipartimento di Ematologia, Unità di Trapianto, Università di Roma “Tor Vergata”, Roma
Michele Troiano, Salvatore Parisi: Divisione di Radioterapia Oncologica – IRCCS Casa Sollievo della Sofferenza, S.Giovanni Rotondo; Alberto Maiorana: Servizio di Fisica Sanitaria – IRCCS Casa Sollievo della Sofferenza, S.Giovanni Rotondo; Angelo Michele Carella: Divisione di Ematologia, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova
Umberto Ricardi, Giuseppe Rossi, Andrea Riccardo Filippi: Radioterapia Ospedale San Giovanni Battista «Le Molinette», Torino; Riccardo Ragona: Servizio di Fisica Sanitaria Ospedale San Giovanni Battista «Le Molinette», Torino
Luigi Tomio: Radioterapia Oncologica, Ospedale Santa Chiara, Trento
Rosa Bianca Guglielmi, Cristina Baiocchi: Radioterapia Ospedale San Bortolo, Vicenza; Paolo Scalchi: Servizio di Fisica Sanitaria Ospedale San Bortolo, Vicenza; Roberto Raimondi: Ematologia Ospedale San Bortolo, Vicenza
Cristiana Vidali S.C.: Radioterapia Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, Trieste; Natasha Maximova: Oncoematologia Pediatrica, Istituto per l’infanzia ed Ospedale specializzato pediatrico regionale - IRCCS “Burlo Garofolo”, Trieste
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Aristei, C., Santucci, A., Corvò, R. et al. In haematopoietic SCT for acute leukemia TBI impacts on relapse but not survival: results of a multicentre observational study. Bone Marrow Transplant 48, 908–914 (2013). https://doi.org/10.1038/bmt.2013.66
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DOI: https://doi.org/10.1038/bmt.2013.66
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