Outcome of single fraction total body irradiation-conditioned stem cell transplantation in younger children with malignant disease Comparison with a busulphan-cyclophosphamide regimen

Lähteenmäki, Päivi; Chakrabarti, Suparno; Cornish, Jacqueline; Oakhill, A

doi:10.1080/02841860310023471

Cited by 12 publications

(6 citation statements)

References 16 publications

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“…Although the use of steroids and TBI was a significant risk factor for cataracts in many reports [4][5][6][12][13][14]16,[18][19][20], neither affected cataract formation in this study. On multivariate analysis, age, acute and extensive chronic GVHD, and systemic infection were identified as the risk factors for cataract.…”

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confidence: 69%

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Incidence, risk factors, and clinical outcomes of cataracts following hematopoietic stem cell transplantation

et al. 2011

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To evaluate the characteristics of cataracts following hematopoietic stem cell transplantation (HSCT), 561 patients without any ocular complications before HSCT were reviewed. Ocular complications occurred in 196 patients (34.9%). Cataract was diagnosed in 45 of 561 patients. The 10-year estimated cataract incidence was 14%. The median onset time was 498 days after transplant (range, 38-4,535 days). The onset of cataracts was later than that of other ocular complications. Phacoemulsification was performed in 13 patients (29%) at a median of 1,028 days after HSCT (range, 375-4,549 days). In 6 of 13 patients (46%) who underwent cataract surgery, visual acuities gradually deteriorated because of the development of posterior capsule opacification. YAG (yttrium-aluminum-garnet) laser posterior capsulotomy successfully recovered their sight without any sequelae. A multivariate analysis revealed that age, acute and chronic graft versus host disease (GVHD), and systemic infection were significant risk factors for cataract, whereas neither steroid nor total body irradiation (TBI)-containing regimens affected the development of cataract. Our results showed that the clinical outcomes of cataract after HSCT are favorable and comparable to those in the general population. Hyperfractionated TBI with eye shielding may be effective for the prevention of cataract.Numerous advances in allogeneic hematopoietic stem cell transplantation (HSCT) techniques have improved recipients' long-term survival. Currently, patients with acute leukemia or chronic myeloid leukemia who survive without recurrent malignancy for 2 years after allogeneic HSCT have an 89% probability of surviving for at least 5 years, and recently, the quality of life (QOL) of such long-term survivors has been investigated [1]. Several reports revealed that a significantly large population of patients developed ocular complications [2,3], such as cataract, dry eye, retinal bleeding, or intraocular infection, and some of these complications affected patients' QOL. Although cataract formation is one of the major late complications following HSCT, its risk factors are still controversial. Previous reports showed that total body irradiation (TBI) increased the risk of cataract, and single dose TBI was more cataractogeneic than hyperfractionated TBI [4]. In the largest series evaluating a cohort of 1,064 patients, risk factors for the development of cataract were older age, higher dose rate (>0.04 Gy/min), allogeneic HSCT, and steroid administration [5].Recently, hyperfractionated TBI has become one of the widespread standard precautions for HSCT-associated complications, and lens protection with custom-made shielding blocks for each patient is also expected to decrease the incidence of cataracts following HSCT [6,7]. Furthermore, cataract surgery has recently become a low-risk procedure and improves visual acuity in more than 90% of eyes in normal healthy subjects [8][9][10][11] but the long-term outcome of surgical repair in patients who undergo HSCT remains to be clarifi...

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confidence: 69%

“…In many previous reports, some patients received single or high dose (>12 Gy) TBI [4,6,[13][14][15][16]. Moreover, TBI was performed without eye shielding [15,18]. Intraocular relapses were observed in four patients, and two patients did not receive TBI (data not shown), which indicates ocular shielding did not increase intraocular relapse.…”

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confidence: 78%

Incidence, risk factors, and clinical outcomes of cataracts following hematopoietic stem cell transplantation

et al. 2011

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“…Generally, TBI treatment is delivered in fractionated technique to reduce acute sequelae, although recently reducedintensity stem cell transplants (RIST) have also been used with single fraction. 21,22 Due to the difficulty in achieving dose uniformity within an acceptable range, a significant advantage of fractionated TBI treatment is the opportunity to use IVD to adapt the plan to deliver appropriate dose to patients over the entire therapy course. TLD, 23 diodes, 16,24 and MOS-FET detectors 25,26 have been used for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Patterns of patient specific dosimetry in total body irradiation

2013

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“…2,3,5 Of particular concern in pediatrics are growth, development, fertility, endocrine function, and long-term organ toxicities, all of which are influenced by the dose and combination of conditioning chemotherapy and radiation. [21][22][23][24][25] A important reason for developing new transplant strategies with reduced-intensity conditioning is to offset some of the early and late toxicities associated with the conditioning regimen. 26 Though targeted to reduce regimen-related toxicity, a reduced intensity or nonmyeloablative approach could tip the balance in favor of GR, especially in the immune competent host.…”

Section: Discussionmentioning

confidence: 99%

A novel reduced-intensity stem cell transplant regimen for nonmalignant disorders

Shenoy

Grossman

DiPersio

et al. 2004

Bone Marrow Transplant

129

110

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Summary:Bone marrow transplantation (BMT) benefits nonmalignant diseases but is limited by regimen-related toxicity, graft-versus-host disease (GVHD), donor availability, and graft rejection (GR). To overcome some of these barriers, we developed a new conditioning strategy for these patients. In total, 16 patients received Campath-1H (33/ 48 mg; days À21 to À19), fludarabine (150 mg/m 2 ; days À8 to À4), melphalan (140/70 mg/m 2 ; day À3), and transplant using related/unrelated stem cells. GVHD prophylaxis included cyclosporine/methylprednisolone for cord cells. Other recipients also received methotrexate. Risk factors for GR included multiple transfusions (6), low stem cell numbers (1), and immunologic/ metabolic disorders (3).

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Outcome of single fraction total body irradiation-conditioned stem cell transplantation in younger children with malignant disease Comparison with a busulphan-cyclophosphamide regimen

Cited by 12 publications

References 16 publications

Incidence, risk factors, and clinical outcomes of cataracts following hematopoietic stem cell transplantation

Incidence, risk factors, and clinical outcomes of cataracts following hematopoietic stem cell transplantation

Patterns of patient specific dosimetry in total body irradiation

A novel reduced-intensity stem cell transplant regimen for nonmalignant disorders

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