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Conditioning Regimens

Fractionated TBI correlates with less T cell mixed chimerism but increased risk of relapse compared to busulphan in patients with haematological malignancies after allogeneic stem cell transplantation

Bone Marrow Transplantation volume 32, pages 477–483 (2003)Cite this article

Summary:

We prospectively evaluated mixed chimerism (MC) in the T cell and myeloid lineages and its correlation to busulphan, single-dose total body irradiation (TBI) and fractionated TBI (fTBI) conditioning in 180 patients with haematological malignancies after allogeneic stem cell transplantation (SCT). In all patients receiving busulphan, the area under curve (AUC) was calculated. The incidence of MC in the T cell lineage was significantly lower in patients receiving fTBI (22%) compared to those given TBI (53%, P=0.02) or busulphan (47%, P<0.01). The incidence of myeloid MC did not differ between the three groups. The overall probability of acute graft-versus-host disease grades II–IV was significantly higher in patients with complete T cell donor chimerism (49%) compared to patients with T cell MC (23%, P<0.001). The incidence of T cell and myeloid MC after SCT did not differ between low (55%), medium (42%) and high (43%) AUC levels of busulphan during conditioning. Patients receiving fTBI had a significantly higher probability of relapse compared to busulphan-treated patients (44 vs l6%, P=0.01). In multivariate analysis adjusted for diagnosis, busulphan-treated patients showed both a better survival (P=0.04) and less probability of relapse (0.03) compared to TBI-treated patients.

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Acknowledgements

We are indebted to Lotta Tammik and Giti Bayat for their excellent technical assistance. We also thank the staff in the Centre for Allogeneic Stem Cell Transplantation, Huddinge University Hospital for competent and compassionate patient care. This study was supported by grants from the Swedish Cancer Foundation (0070-B96-10XAC; 4147-B99-02XBB), the Children's Cancer Foundation (1998-002; 2001-059), the Swedish Medical Research Council (K97-06X-05971-17A), the Tobias Foundation, the FRF Foundation and Ellen Bechrach Foundation, Stockholm Cancer Society 02:119.

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Authors and Affiliations

  1. Centre for Allogeneic Stem Cell Transplantation, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden

    J Mattsson

  2. Department of Clinical Immunology, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden

    J Mattsson, M Uzunel & M Remberger

  3. Department of Haematology, Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden

    M Hassan

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Mattsson, J., Uzunel, M., Remberger, M. et al. Fractionated TBI correlates with less T cell mixed chimerism but increased risk of relapse compared to busulphan in patients with haematological malignancies after allogeneic stem cell transplantation. Bone Marrow Transplant 32, 477–483 (2003). https://doi.org/10.1038/sj.bmt.1704154

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