Abstract
Reduced-intensity stem cell transplantation (RIST) minimizes the adverse effects of traditional hematopoietic stem cell transplantation, and low-dose total-body irradiation (TBI) is administered over a short period prior to RIST (TBI–RIST). Different institutes adopt different approaches for the administration of TBI–RIST, and since no study had previously investigated this issue, a survey of the TBI schedules in Japan was conducted. In October 2015, the Japanese Radiation Oncology Study Group initiated a national survey of TBI–RIST procedures conducted between 2010 and 2014. Of 186 institutions performing TBI, 90 (48%) responded to the survey, 78 of which performed TBI–RIST. Of 2488 patients who underwent TBI for malignant disease at these institutions, 1412 (56.8%) patients were treated for leukemia, 477 (19.2%) for malignant lymphoma, 453 (18.2) for myelodysplastic syndrome, 44 (1.8%) for multiple myeloma, and 102 (4.1%) for other malignant diseases. Further, 206 (52.0%) of 396 patients (a high proportion of patients) who underwent TBI for benign disease had aplastic anemia. The TBI–RIST equipment and treatment methods were similar to those used for myeloablative regimens. Routinely shielded organs included the lungs (43.6%), eyes (50.0%) and kidneys (10.2%). The ovaries (14.1%), thyroid (6.4%) and testicles (16.7%) were also frequently shielded, possibly reflecting an emphasis on shielding reproductive organs in children. TBI–RIST was performed more frequently than myeloablative conditioning in patients with benign disease. Genital and thyroid shielding were applied more frequently in patients treated with TBI–RIST than in patients treated with myeloablative conditioning. In conclusion, this study indicates the status of TBI–RIST in Japan and can assist future efforts to standardize TBI–RIST treatment methods and to design a future multicenter collaborative research study.
Highlights
Prior to hematopoietic stem cell transplantation, patients undergo myeloablative conditioning, which typically involves high-dose chemotherapy or total body irradiation (TBI)
Other reports concluded that TBI–reducedintensity stem cell transplantation (RIST) led to significantly better outcomes [2, 3]
The treatment techniques were similar between TBI–RIST and myeloablative TBI
Summary
Prior to hematopoietic stem cell transplantation, patients undergo myeloablative conditioning, which typically involves high-dose chemotherapy or total body irradiation (TBI). Conditioning regimens serve to attenuate the immunity of the recipient and facilitate the attachment of donor cells to the recipient’s bone marrow. These conditioning regimens are often contraindicated in elderly patients and patients with poor general condition due to their high therapeutic strength. Reducedintensity stem cell transplantation (RIST) is thought to induce GVL effects via the use of immunosuppressive drugs, a shortened schedule of TBI is sometimes added to the conditioning regimen in clinical practice. No study to date has surveyed TBI schedules for non-myeloablative methods in Japan. The Japanese Radiation Oncology Study Group (JROSG) designed and administered a national survey questionnaire on non-myeloablative TBI and the use of TBI in myeloablative regimens. We describe the findings for non-myeloablative TBI and compare these findings with those for myeloablative TBI presented in our previous report
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