Toxicities of total-body irradiation for pediatric bone marrow transplantation

Summary:We evaluated the 100-day mortality rates associated with busulfan-based myeloablative conditioning regimens based on data from 1812 chronic myelogenous leukemia patients who underwent allogeneic blood or marrow transplantation (allotx). In all, 47 patients received intravenous (i.v.) busulfan and cyclophosphamide (i.v.BuCy2) with allotx at MD Anderson Cancer Center (MDACC) during 1995-1999. The remaining 1765 patients, whose data were supplied by the International Bone Marrow Transplant Registry (IBMTR), received alternative preparative regimens, primarily Cy-total body irradiation (B45%) or oral BuCy (B35%) during 1997-1998. As patients were not randomized between conditioning regimens, the i.v.BuCy2-versus-alternative treatment effect is confounded with a possible center effect due to nontreatment differences associated with factors differing between MDACC and the IBMTR centers. Additional complications are that the i.v.BuCy2-MDACC patients all survived 100 days, and three prognostic subgroups were included. Bayesian sensitivity analyses were performed to assess treatment effect on the probability of 100-day mortality, over a range of possible MDACC-versus-IBMTR center effects. For these patients, the posterior probability that i.v.BuCy2 was superior to alternative conditioning regimens ranges from 0.54 to 0.99, depending on prognosis and the magnitude of the assumed center effect.

Section: Discussionmentioning

confidence: 99%

Comparison of 100-day mortality rates associated with i.v. busulfan and cyclophosphamide vs other preparative regimens in allogeneic bone marrow transplantation for chronic myelogenous leukemia: Bayesian sensitivity analyses of confounded treatment and center effects

Thall

Champlin

Andersson

2004

“…There have been many publications concerning quality of life after BMT in adults giving contradictory results [10][11][12] and several reports on late effects concerning single organ systems in pediatric BMT patients [13][14][15] but there are very few data concerning overall heath status and quality of life in this patient group. 6,16,17 The aim of this single-center study was to detect major organ toxicity 1 and 3 years after BMT and major restriction in 'normal life' in a large unselected heterogeneous group of pediatric BMT patients.…”

Section: Discussionmentioning

confidence: 99%

Organ toxicity and quality of life after allogeneic bone marrow transplantation in pediatric patients: a single centre retrospective analysis

Matthes‐Martin

Lamche

Ladenstein

et al. 1999

Summary:One hundred and fifty five pediatric patients underwent allogeneic bone marrow transplantation between 1980 and 1996 in the St Anna Children's Hospital in Vienna with an overall survival of 52.3% (81 patients). Seventythree patients with a minimum observation time of 1 year (1-13 years, median: 4.6) were analyzed retrospectively for chronic GVHD, organ toxicity (WHO score), growth and pubertal development. Chronic GVHD was diagnosed in 20 patients (27.3%), being extensive in 17 cases. Maximum organ toxicity was WHO III in two patients (3%) and WHO II in 11 patients (15%) 1 year after BMT and WHO III in one patient (2%) and WHO II in five patients (11%) 3 years after BMT. Impaired growth and pubertal development were detected in more than 30% 3 years after BMT. As all patients presented with a Karnofsky or Lansky score of more than 80%, they were asked to complete a questionnaire comprising 12 questions concerning physical state of health and psychosocial state of health. Restricted contacts were classified as imposing a severe handicap by six patients (8%), restriction in mobility and 'normal life activities' by three patients (4%) and two patients classified themselves as severely physically handicapped. Most patients (75%) reported no physical or psychical impairment.

“…[2][3][4][5][6] To our knowledge, there have been only 21 reported observations of OS essentially found in the long bones following HSCT ( Table 2). All were in children aged less than 8 years at the time of transplantation and all had received TBI (fractionated in eight (12 Gy), single dose (7 Gy) in four, unknown fractionation in nine (9-14.4 Gy)) ( Table 2) as part of the conditioning regimen.…”

Section: Discussionmentioning

confidence: 99%

“…Cataract, airway and pulmonary disease, secondary malignancies and musculo-skeletal problems are also frequent compli- cations. 1,2 Among these latter, osteochondroma have been reported only rarely, [3][4][5][6] although this condition is wellknown after local irradiation in children. [7][8][9][10] We report eight children who developed an osteochondroma following HSCT.…”

mentioning

confidence: 99%

Osteochondroma after pediatric hematopoietic stem cell transplantation: report of eight cases

Bordigoni

Clément

et al. 2002

Summary:Eight children developed osteochondroma (OS) at a mean of 88 months after hematopoietic stem cell transplantation (HSCT). The mean age at HSCT was 56 months (12-84). This represents a cumulative incidence of 20% among patients less than 18 years of age transplanted from 1981 to 1997. These eight patients underwent allogeneic (n = 2) or autologous (n = 6) transplantation for either acute leukemia (n = 6) or neuroblastoma (n = 2) after a conditioning regimen including TBI (n = 7) or a combination of Bu and CY. OS was multiple in seven patients and solitary in one. Eight lesions were resected and all were benign. Four children received growth hormone before diagnosis of OS, but there was no clinical, radiological or histological difference between those who did not. Univariate analysis showed an increased rate associated only with autologous HSCT, with a 31.7% probability of a new OS at 12 years after HSCT. Osteochondroma should be added to the other adverse effects of HSCT in children.