Total Body Irradiation–Based Conditioning Regimen Improved the Survival of Adult Patients With T-Cell Lymphoblastic Lymphoma After Allogeneic Peripheral Blood Stem Cell Transplantation

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is one of the consolidation modalities for adult patients with T-cell lymphoblastic lymphoma (T-LBL). However, the optimal conditioning regimen needs to be explored. In the present study, 40 patients with T-LBL undergoing allo-HSCT were retrospectively analyzed, including 23/40 (57.5%) with total body irradiation (TBI)–based conditioning regimen and 17/40 (42.5%) with busulfan (BU)-based regimen. TBI–based regimen significantly increased the cumulative incidence (CI) of grade II to IV acute graft-versus-host disease (aGvHD) as compared with BU-based regimen (13.0% vs 0%, P = 0.000). The relapse risk was significantly lowered in TBI-based group with a 2-year CI of relapse (CIR) of 9.1% as compared with that of 49.6% in BU-based group ( P = 0.008). The 1-year and 2-year non-relapse mortalities (NRMs) for all patients were 5.0% and 10.3%, respectively. The 1-year and 2-year NRMs were 8.9% and 16.0% in TBI-based group, and 0.00% and 0.00% in BU-based group ( P = 0.140). The 2-year probabilities of overall survival (OS) and relapse-free survival (RFS) were 83.0% [95% confidence interval, 63.4%–100%] and 74.0% (95% confidence interval, 54.4%–93.6%) in TBI-based group, which were higher than that of 35.0% (95% confidence interval, 0.0%–72.2%) and 50.0% (95% confidence interval, 24.5%–75.4%) in BU-based group, respectively ( P = 0.020 for OS and P = 0.081 for RFS). In multivariate analysis, TBI-based regimen significantly reduced the risk of relapse [subdistribution hazard ratio (SHR) = 0.030, 95% CI, 0.002–0.040, P = 0.000] and improved the OS [hazard ratio (HR) 0.121, 95% CI, 0.021–0.683, P = 0.017] as an independent prognostic factor. These results suggested that TBI-based regimen might be an optimal choice for adult patients with T-LBL undergoing allo-HSCT.

Chidamide combined with a modified Bu-Cy conditioning regimen improves survival in patients with T-cell acute lymphoblastic leukemia/lymphoma undergoing allogeneic hematopoietic stem cell transplantation.

“…Multivariate analysis also suggested that the Chi regimen was associated with superior OS and LFS. Currently, TBI-based regimens are more recommended than chemo-based regimens for conditioning of T-ALL [34,35]. Compared to the TBI-based conditioning regimen, a report from the acute leukemia working party of EBMT, our outcomes displayed a higher 2year OS (80.8 vs. about 60%).…”

Colonization by multidrug‐resistant bacteria in hematological patients undergoing hematopoietic stem cell transplantation and clinical outcomes: A single‐center retrospective cohort study

“…In animal models, TBI is associated with substantial intestinal injury and with a decrease in intestinal microbial diversity 43,44,45 . Despite the fact that the use of high‐dose TBI was a risk factor for bacteremia and death by colonizing bacteria in this cohort, TBI‐based conditioning regimens are an important strategy for preventing disease relapse and improving overall survival in patients with acute lymphoblastic leukemia, 46,47 and TBI‐based regimens should not be discouraged without additional evidence. To our knowledge, this is the first study associating the use of high‐dose TBI in conditioning with an increased probability of death after bacteremia by the same previously colonizing MDR bacterium.…”

Investigation of Allogeneic Neutrophil Transfusion in Improving Survival Rates of Severe Infection Mice

“…This reaction could be linked to the human leukocyte antigen (HLA) antigens present on the neutrophil surface, as well as the small number of erythrocytes and monocytes that accompany the graft 28 – 33 . Some authors have indicated possible symptoms of fever and impaired lung function in patients following neutrophil transfusion 34 , this symptom may resemble the occurrence of a cytokine storm observed during chimeric antigen receptor (CAR)-T cell therapy 35 , 36 , underscoring the importance of addressing immune rejection. Therefore, we used magnetic bead sorting to purify neutrophils (neutrophil purity approximately is 90%) and eliminate erythrocytes and other heterocytes, thereby minimizing the possibility of immune rejection.…”