In a nutshell
This study aimed to investigate if chemotherapy (CT) conditioning could replace total body irradiation (TBI) before stem cell transplant (SCT) in children with acute lymphoblastic leukemia (ALL).
This study concluded that TBI in combination with CT was safer and more effective than CT conditioning alone in these patients.
Some background
TBI involves giving radiation to the whole body to kill cancer cells. It is done in preparation for allogeneic hematopoietic stem cell transplantation (alloHSCT). AlloHSCT is where healthy stem cells from a donor are transplanted to the patient to replace cells lost during cancer treatment. TBI conditioning is commonly used for children with ALL. However, long-term side effects such as slowing down growth and sexual development and the risk of second cancers are concerning.
CT drug combinations may be safer when used before alloHSCT. However, it was unknown if preparative combination CT could replace TBI in children with ALL undergoing alloHSCT.
Methods & findings
This study involved 413 children with ALL undergoing alloHSCT. 212 patients were treated with TBI and 201 patients were treated with CT conditioning before the transplant. The average follow up time was 2.1 years.
The 2-year overall survival (OS) rate was significantly higher following TBI when compared to CT-conditioning. Also, the 2-year occurrence of relapse and treatment-related mortality were lower with TBI when compared to CT-conditioning.
The bottom line
This study concluded that TBI plus etoposide (Etopophos) chemotherapy provided better outcomes for children with ALL compared to CT-conditioning alone before alloHSCT.
The fine print
This study had a short follow-up period. Toxic effects of TBI can be seen after a long time.
Published By :
Journal of clinical oncology
Date :
Dec 17, 2020
