Health status of childhood leukemia survivors who received hematopoietic cell transplantation after BU or TBI: an LEA study

Abstract

The purpose of this multicenter study was to compare the long-term impact of a preparative regimen with either BUBU or TBI on health status and quality of life (QoL) in childhood acute leukemia survivors treated with hematopoietic SCT (HSCT). Two-hundred and forty patients were included. Sixty-six had received BU, while 174 had received TBI. Median follow-up from HSCT was 10.1 years. Multivariate analyses were performed to assess the occurrence of late effects according to treatment. QoL was assessed in 130 adults using SF-36 questionnaires. Patients developed fewer late complications after BU (2.35 vs 3.01, P ¼ 0.03) while the risk to present with at least one complication was equivalent in both groups (87.9% after BU and 93.1% after TBI, P ¼ 0.66). Detailed multivariate analyses revealed a lower risk of height growth failure (OR ¼ 0.2), cataract (OR ¼ 0.1) and iron overload (OR ¼ 0.2) after BU, and an increased risk of overweight (OR ¼ 3.9) and alopecia (OR ¼ 11.2). SF-36 mental and physical composite scores were similar in both treatment groups and proved significantly lower than French norms. Late effects induced by BU might differ from those experienced after TBI. Although less frequent, they are still of considerable importance and may affect patients' QoL.

Incidence and severity of crucial late effects after allogeneic HSCT for malignancy under the age of 3 years: TBI is what really matters

“…3,5,13,[15][16][17]27,[45][46][47][48][49][50][51] Age 2-3 years at HSCT was a RF for both thyroid dysfunction and growth disturbance, and the significant correlation with a higher proportion of TBI within this age group further highlights the harmful impact of TBI. The incidence of severe CNS LE was higher in the TBI-conditioned as compared with the chemo-conditioned patients (47 vs 21%).…”

A Chemotherapy-Only Regimen of Busulfan, Melphalan, and Fludarabine, and Rabbit Antithymocyte Globulin Followed by Allogeneic T-Cell Depleted Hematopoietic Stem Cell Transplantations for the Treatment of Myeloid Malignancies

“…The major complications associated with this therapeutic approach have included GvHD 24 , and the acute and late effects of cytoreductive regimens that have included TBI 25–33 . In this report we describe a chemotherapy-only cytoreductive approach to successfully engraft T-cell depleted transplants from a variety of donors, including matched and mismatched, related and unrelated, all with a low risk of GvHD, and while maintaining relapse rates comparable to other approaches.…”

Adverse health events and late mortality after pediatric allogeneic hematopoietic SCT—two decades of longitudinal follow-up

“…20 After extended follow-up, BU seems to be the less toxic myeloablative alternative to TBI and this is supported by other reports. 3,6,21,22 Health conditions that are known to predispose to other, more disabling or life-threatening events were common among the HSCT survivors. Consistent with other studies, 23-25 many of the survivors suffered from metabolic disorders: diabetes type II (9%); dyslipidemia (7%); and hypertension (7%), all well-known risk factors for cardiovascular events.…”