Optimized Conformal Total Body Irradiation Among Recipients of TCRαβ/CD19-Depleted Grafts in Pediatric Patients With Hematologic Malignancies: Single-Center Experience

• DOI: 10.3389/fonc.2021.785916
• Publication Date: 2021-12-16T06:40:17Z
• Authors: Daria Kobyzeva; Larisa Shelikhova; Anna Loginova; Francheska Kanestri; Diana Tovmasyan; Michael Maschan; Rimma Khismatullina; Mariya Ilushina; Dina Baidildina; Natalya Myakova; Alexey Nechesnyuk
• Keywords: Total body irradiation; Tomotherapy; Cumulative incidence; Induction chemotherapy

Total body irradiation (TBI) in combination with chemotherapy is widely used as a conditioning regimen pediatric and adult hematopoietic stem cell transplantation (HSCT). The of TBI has demonstrated superior survival outcomes patients acute lymphoblastic myeloid leukemia when compared regimens based only on chemotherapy. clinical application intensity-modulated radiation therapy (IMRT)-based methods (volumetric modulated arc (VMAT) TomoTherapy) seems to be promising been actively worldwide. optimized conformal total (OC-TBI) method described this study provides selected dose reduction for organs at risk respect the most significant toxicity (lungs, kidneys, lenses). This included 220 who received OC-TBI subsequent allogenic HSCT TCRαβ/CD19 depletion. A group 151 using TomoTherapy, 40 Elekta Synergy™ linac an Agility-MLC (Elekta, Crawley, UK) volumetric (VMAT). Twenty-nine supplemental simultaneous boost bone marrow—(SIB BM) up 15 Gy: 28 (pts)—TomoTherapy; one patient—VMAT. follow-up duration ranged from 0.3 6.4 years (median follow-up, 2.8 years). Overall (OS) all was 63% (95% CI: 56–70), event-free (EFS) 58% 51–65). cumulative incidence transplant-related mortality (TRM) 10.7% 2.2–16) patients. early TRM (<100 days) 5.0% 1.5–8.9), that late (>100 5.7 1.7–10.2). main causes death were relapse infection. concept IMRT VMAT helical treatment delivery TomoTherapy unit maximum control distribution extended targets risk. low severe side effects after predictable effectiveness. Our initial experience demonstrates appears technique