PMID- 10078628
OWN - NLM
STAT- MEDLINE
DCOM- 19990318
LR  - 20190708
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 43
IP  - 3
DP  - 1999 Feb 1
TI  - Total body irradiation correlates with chronic graft versus host disease and 
      affects prognosis of patients with acute lymphoblastic leukemia receiving an HLA 
      identical allogeneic bone marrow transplant.
PG  - 497-503
AB  - PURPOSE: To investigate whether different procedure variables involved in the 
      delivery of fractionated total body irradiation (TBI) impact on prognosis of 
      patients affected by acute lymphoblastic leukemia (ALL) receiving allogeneic bone 
      marrow transplant (BMT). METHODS AND MATERIALS: Ninety-three consecutive patients 
      with ALL receiving a human leukocyte antigen (HLA) identical allogeneic BMT 
      between 1 August 1983 and 30 September 1995 were conditioned with the same 
      protocol consisting of cyclophosphamide and fractionated TBI. The planned total 
      dose of TBI was 12 Gy (2 Gy, twice a day for 3 days). Along the 12-year period, 
      variations in delivering TBI schedule occurred with regard to used radiation 
      source, instantaneous dose rate, technical setting, and actual total dose 
      received by the patient. We tested these different TBI variables as well as 
      factors related to patient, state of disease, and transplant-induced disease to 
      investigate their influence on transplant-related mortality, leukemia relapse, 
      and survival. RESULTS: At median follow-up of 7 years (range 3-15 years) the 
      probabilities of leukemia-free survival (LFS) and overall survival (OS) for the 
      93 patients were 60% and 41%, respectively. At univariate analysis, chronic graft 
      versus host disease (cGvHd) (p = 0.0005), age (p = 0.01), and state of disease (p 
      = 0.03) were factors affecting LFS whereas chronic GvHd (p = 0.0005), acute GvHd 
      (p = 0.03), age (p = 0.0001), and GvHd prophylaxis (p = 0.01) were factors 
      affecting overall survival. The occurrence of chronic GvHd was correlated with 
      actually delivered TBI dose (p = 0.04). Combined stratification of prognostic 
      factors showed that patients who received the planned total dose of TBI (12 Gy) 
      and were affected by chronic GvHd had higher probabilities of LFS (p = 0.01) and 
      OS (p = n.s.) than patients receiving less than 12 Gy and/or without occurrence 
      of chronic GvHd. Moreover, TBI dose had a significant impact on LFS in patients 
      transplanted in first remission (p = 0.05). At multivariate analysis, TBI dose 
      was an independent factor affecting overall survival (p = 0.05) as well as 
      chronic GvHd (p = 0.001) and age (p = 0.04). CONCLUSIONS: This retrospective 
      analysis showed that different variables involved in TBI delivery may influence 
      the occurrence of cGvHd and affect prognosis of patients with ALL receiving 
      allogeneic BMT. The total dose of 12 Gy, administered in six fractions over 3 
      days, appears to be an effective and low toxic regimen for ALL patients 
      transplanted in first remission.
FAU - Corvo, R
AU  - Corvo R
AD  - Servizio di Oncologia Radioterapica, Istituto Nazionale per la Ricerca sul Cancro 
      di Genova, Italy.
FAU - Paoli, G
AU  - Paoli G
FAU - Barra, S
AU  - Barra S
FAU - Bacigalupo, A
AU  - Bacigalupo A
FAU - Van Lint, M T
AU  - Van Lint MT
FAU - Franzone, P
AU  - Franzone P
FAU - Frassoni, F
AU  - Frassoni F
FAU - Scarpati, D
AU  - Scarpati D
FAU - Bacigalupo, A
AU  - Bacigalupo A
FAU - Vitale, V
AU  - Vitale V
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Analysis of Variance
MH  - *Bone Marrow Transplantation/immunology
MH  - Chronic Disease
MH  - Disease-Free Survival
MH  - Dose Fractionation, Radiation
MH  - Female
MH  - Follow-Up Studies
MH  - Graft vs Host Disease/*etiology/mortality
MH  - Humans
MH  - Male
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality/radiotherapy/*therapy
MH  - Prognosis
MH  - Radiation Pneumonitis/etiology
MH  - Retrospective Studies
MH  - Transplantation Conditioning
MH  - Transplantation, Homologous
MH  - *Whole-Body Irradiation
EDAT- 1999/03/17 00:00
MHDA- 1999/03/17 00:01
CRDT- 1999/03/17 00:00
PHST- 1999/03/17 00:00 [pubmed]
PHST- 1999/03/17 00:01 [medline]
PHST- 1999/03/17 00:00 [entrez]
AID - S0360-3016(98)00441-6 [pii]
AID - 10.1016/s0360-3016(98)00441-6 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 1999 Feb 1;43(3):497-503. doi: 
      10.1016/s0360-3016(98)00441-6.