The impacts of total body irradiation on umbilical cord blood hematopoietic stem cell transplantation

• Published in: Therapeutic advances in hematology Vol. 14; p. 20406207231170708
• Main Authors: Wang, Hao, Berger, Kristin N., Miller, Elizabeth L., Fu, Wei, Broglie, Larisa, Goldman, Frederick D., Konig, Heiko, Lim, Su Jin, Berg, Arthur S., Talano, Julie-An, Comito, Melanie A., Farag, Sherif S., Pu, Jeffrey J.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-01-2023; Sage Publications Ltd; SAGE Publishing
• Subjects: Human exposure; Original Research; Radiation; Stem cell transplantation; Transplants & implants; Umbilical cord; Myeloablative considition; umbilical cord blood hematopoietic stem cell transplantation; total body irradiation; reduced-intensity condition; post cord blood hematological stem cell transplant outcome
• ISSN: 2040-6207; 2040-6215
• DOI: 10.1177/20406207231170708

Background:
Umbilical cord blood hematopoietic stem cells are commonly used for hematopoietic system reconstitution in recipients after umbilical cord blood transplantation (UCBT). However, the optimal conditioning regimen for UCBT remains a topic of debate. The exact impact of total body irradiation (TBI) as a part of conditioning regimens remains unknown.
Objectives:
The aim of this study was to evaluate the impacts of TBI on UCBT outcomes.
Design:
This was a multi-institution retrospective study.
Methods:
A retrospective analysis was conducted on the outcomes of 136 patients receiving UCBT. Sixty-nine patients received myeloablative conditioning (MAC), in which 33 underwent TBI and 36 did not, and 67 patients received reduced-intensity conditioning (RIC), in which 43 underwent TBI and 24 did not. Univariate and multivariate analyses were conducted to compare the outcomes and the post-transplant complications between patients who did and did not undergo TBI in the MAC subgroup and RIC subgroup, respectively.
Results:
In the RIC subgroup, patients who underwent TBI had superior overall survival (adjusted hazard ratio [aHR] = 0.25, 95% confidence interval [CI]: 0.09–0.66, p = 0.005) and progression-free survival (aHR = 0.26, 95% CI: 0.10–0.66, p = 0.005). However, in the MAC subgroup, there were no statistically significant differences between those receiving and not receiving TBI.
Conclusion:
In the setting of RIC in UCBT, TBI utilization can improve overall survival and progression-free survival. However, TBI does not show superiority in the MAC setting.