Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2026
Outcomes of two or more rounds of hematopoietic stem cell transplantation using total body irradiation for hematological malignancies.
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Murofushi Keiko Nemoto, Najima Yuho, Kito Satoshi, Handa Emi, Ogoshi Yumi, Taguchi Kentaro, Hayakawa Sara, Ito Kei, Shimizuguchi Takuya, Toya Takashi, Morita Kaoru, Shimizu Hiroaki, Doki Noriko
Аннотация
BACKGROUND AND PURPOSE: Relapse after allogeneic hematopoietic stem cell transplantations (allo-HSCT) carries poor outcomes, often necessitating a second transplant. However, toxicity concerns limit repeated total body irradiation (TBI), and its impact in later allo-HSCT is largely unknown. We evaluated outcomes of patients with hematological malignancies who underwent ≥ 2 allo-HSCTs incorporating TBI for graft failure or relapse.
MATERIALS AND METHODS: We analyzed 37 patients who underwent TBI ≥ 2 times with a cumulative dose > 12 Gy. TBI was delivered using either two-dimensional radiotherapy or intensity-modulated radiation therapy. Myeloablative conditioning consisted of 12 Gy in six fractions, and reduced-intensity conditioning consisted of 3-4 Gy in two fractions.
RESULTS: Median follow-up among survivors was 64.9 months. Thirty-one patients received TBI twice and six received TBI three times. The median cumulative dose was 16 Gy. The 1- and 2-year overall survival rates were 48.6% and 27.0%, respectively; the non-relapse mortality rates were 31.4% and 49.9%, respectively. Median cumulative doses to the lungs, kidneys, and liver were 10.8, 11.7, and 16.0 Gy, respectively. After the second allo-HSCT, one patient developed Bearman grade ≥ 3 or late grade ≥ 3 adverse events in the lungs (10.8 Gy), seven in the kidneys (median, 11.7 Gy), and four in the liver (17.2 Gy). No association was observed between cumulative organs-at-risk dose and grade ≥ 3 toxicities.
CONCLUSION: Second or third allo-HSCT incorporating repeated TBI with alternating myeloablative and non-myeloablative doses achieved salvage for a relatively substantial number of patients with tolerable toxicity, given the high-risk status of disease and repeated allo-HSCT.
MATERIALS AND METHODS: We analyzed 37 patients who underwent TBI ≥ 2 times with a cumulative dose > 12 Gy. TBI was delivered using either two-dimensional radiotherapy or intensity-modulated radiation therapy. Myeloablative conditioning consisted of 12 Gy in six fractions, and reduced-intensity conditioning consisted of 3-4 Gy in two fractions.
RESULTS: Median follow-up among survivors was 64.9 months. Thirty-one patients received TBI twice and six received TBI three times. The median cumulative dose was 16 Gy. The 1- and 2-year overall survival rates were 48.6% and 27.0%, respectively; the non-relapse mortality rates were 31.4% and 49.9%, respectively. Median cumulative doses to the lungs, kidneys, and liver were 10.8, 11.7, and 16.0 Gy, respectively. After the second allo-HSCT, one patient developed Bearman grade ≥ 3 or late grade ≥ 3 adverse events in the lungs (10.8 Gy), seven in the kidneys (median, 11.7 Gy), and four in the liver (17.2 Gy). No association was observed between cumulative organs-at-risk dose and grade ≥ 3 toxicities.
CONCLUSION: Second or third allo-HSCT incorporating repeated TBI with alternating myeloablative and non-myeloablative doses achieved salvage for a relatively substantial number of patients with tolerable toxicity, given the high-risk status of disease and repeated allo-HSCT.