The role of total body irradiation (TBI) as a conditioning regime for paediatric acute lymphoblastic leukaemia: A discussion of the evidence

Hill, Gareth; Meikle, Dora

doi:10.1016/j.radi.2015.04.003

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…(1) This is an important finding, that should however be weighed against the well-known late toxic effects of TBI in long term survivors. (2)(3)(4)(5) In AML patients, the effects of conditioning regimens on outcome after HCT are not well studied. Since the 1990's, conditioning with Busulfan (Bu), Cyclofosfamide (Cy), and Melfalan (Mel) is a commonly used preparative regimen, (6) with proven efficacy in pediatric AML in terms of EFS (between 61%-73%).…”

Section: Introductionmentioning

confidence: 99%

Clofarabine-fludarabine-busulfan in HCT for pediatric leukemia: an effective, low toxicity, TBI-free conditioning regimen

et al. 2022

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We prospectively studied CloFluBu-conditioning in allogeneic Hematopoietic Cell Therapy (HCT) for lymphoid- and myeloid malignancies, and hypothesized that CloFluBu provides a less toxic alternative to conventional conditioning regimens, with adequate anti-leukemic activity. All patients receiving their first HCT, from 2011-2019, were included and received CloFluBu. Primary endpoint was Event Free Survival (EFS). Secondary endpoints were Overall Survival (OS), Graft-versus-Host-Disease (GvHD)-Relapse-Free Survival (GRFS), Treatment Related Mortality (TRM), Cumulative Incidence of Relapse (CIR), acute and chronic GvHD, and veno-occlusive disease (VOD). Cox Proportional Hazard- and Fine and Gray competing-risk models were used for data analysis. 155 Children were included; 60 acute lymphoid leukemia (ALL), 69 acute myeloid leukemia (AML), and 26 other malignancies (mostly MDS-EB). Median age was 9.7 (0.5-18.6) years. Estimated 2-yr EFS was 72.0% ± 6.0 in ALL, and 62.4% ± 6.0 in AML patients. TRM in the whole cohort was 11.0% ± 2.6, incidence of aGvHD III-IV at 6 months was 12.3% ± 2.7, extensive chronic GvHD at 2-yr was 6.4% ± 2.1. Minimal residual disease-positivity prior to HCT was associated with higher CIR, both in ALL and AML. CloFluBu showed limited toxicity and encouraging EFS. CloFluBu is a potentially less toxic alternative to conventional conditioning regimens. Randomized prospective studies are needed.

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Section: Introductionmentioning

confidence: 99%

Clofarabine-fludarabine-busulfan in HCT for pediatric leukemia: an effective, low toxicity, TBI-free conditioning regimen

et al. 2022

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An evaluation of ankle and foot bolus in paediatric modulated arc total body irradiation (MATBI)

Hering,

Effeney,

Brady

et al. 2024

J of Medical Radiation Sci

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IntroductionThis retrospective planning study aimed to evaluate the role of bolus in achieving dose uniformity in the ankles and feet in paediatric patients undergoing Modulated Arc Total Body Irradiation (MATBI) treatment and to identify patient factors that may negate or warrant its use.MethodsThe clinically treated plans of 20 paediatric patients who received MATBI treatment utilising ankle and foot bolus (Bolus plan) were compared with two retrospectively generated plans; a plan with bolus removed and no re‐optimisation (No Bolus plan), and a re‐optimised plan without bolus attempting to achieve equal dosimetry to the clinical plan via monitor unit adjustment (MU plan). Descriptive statistics were used to evaluate the dose uniformity criteria of ±10% coverage of the reference dose (RD) for each subregion of the ankle and foot for the three plans. The impact of patient height, weight, and age at the time of treatment was evaluated using Spearman's correlation.ResultsVariation in doses >10% RD was minimal across the three plans, with an average D1cc difference < 0.4Gy. For the ankle and foot regions in the Bolus plans, the volume receiving at least 90% of the RD (V90) was on average > 92%. In No Bolus and MU plans, there was an average reduction of 24.5% and 23.2% V90 coverage respectively in the toes. Spearman's correlation suggests height has the strongest relationship to D1cc.ConclusionThis study validated the continued use of ankle and foot bolus to achieve dosimetric goals for paediatric MATBI treatments, particularly V90 coverage across all heights.

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The role of total body irradiation (TBI) as a conditioning regime for paediatric acute lymphoblastic leukaemia: A discussion of the evidence

Cited by 2 publications

References 19 publications

Clofarabine-fludarabine-busulfan in HCT for pediatric leukemia: an effective, low toxicity, TBI-free conditioning regimen

Clofarabine-fludarabine-busulfan in HCT for pediatric leukemia: an effective, low toxicity, TBI-free conditioning regimen

An evaluation of ankle and foot bolus in paediatric modulated arc total body irradiation (MATBI)

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