Myeloablative conditioning with total body irradiation for AML: Balancing survival and pulmonary toxicity.
Abstract
PURPOSE: The purpose of this study was to compare leukemia-free survival (LFS) and
other clinical outcomes in patients with acute myelogenous leukemia who underwent a myeloablative
allogeneic stem cell transplant with and without total body irradiation (TBI). METHODS
AND MATERIALS: Adult patients with acute myelogenous leukemia undergoing myeloablative
allogeneic stem cell transplant at Duke University Medical Center between 1995 and
2012 were included. The primary endpoint was LFS. Secondary outcomes included overall
survival (OS), nonrelapse mortality, and the risk of pulmonary toxicity. Kaplan-Meier
survival estimates and Cox proportional hazards multivariate analyses were performed.
RESULTS: A total of 206 patients were evaluated: 90 received TBI-based conditioning
regimens and 116 received chemotherapy alone. Median follow-up was 36 months. For
all patients, 2-year LFS and OS were 36% (95% confidence interval [CI], 29-43) and
39% (95% CI, 32-46), respectively. After adjusting for known prognostic factors using
a multivariate analysis, TBI was associated with improved LFS (hazard ratio: 0.63;
95% CI: 0.44-0.91) and OS (hazard ratio: 0.63; 95% CI, 0.43-0.91). There was no difference
in nonrelapse mortality between cohorts, but pulmonary toxicity was significantly
more common with TBI (2-year incidence 42% vs 12%,P< .001). High-grade pulmonary toxicity
predominated with both conditioning strategies (70% and 93% of cases were grade 3-5
with TBI and chemotherapy alone, respectively). CONCLUSIONS: TBI-based regimens were
associated with superior LFS and OS but at the cost of increased pulmonary toxicity.
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https://hdl.handle.net/10161/16167Published Version (Please cite this version)
10.1016/j.adro.2016.07.001Collections
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Show full item recordScholars@Duke
Nelson Jen An Chao
Donald D. and Elizabeth G. Cooke Cancer Distinguished Research Professor
My research interests are in two broad areas, clinical hematopoietic stem cell and
cord blood transplantation and in the laboratory studies related to graft vs. host
disease and immune reconstitution. On the clinical side we are currently conducting
approximately 50 different clinical protocols ranging from preparatory regimens, supportive
care studies and disease specific protocols. Most of these clinical studies are centered
around studies of the sources of stem cells and the methods to
Mitchell Eric Horwitz
Professor of Medicine
Allogeneic stem cell transplantation with a focus on the use of umbilical cord blood
grafts; Allogenic stem cell transplantation for Sickle Cell Disease; Prevention of
acute and chronic graft versus host disease; Improving immune recovery following alternative
donor stem cell transplantation using donor graft manipulation.
Christopher Ryan Kelsey
Professor of Radiation Oncology
Clinical trials that are currently enrolling patients include a study investigating
lower doses of radiation therapy for patients with diffuse large B-cell lymphoma,
with the goal of maintaining excellent tumor control but decreasing the risk of long-term
side effects of treatment. I also have an interest in genetic determinants of radiation
sensitivity, predictors of local recurrence after surgery for lung cancer, radiation-induced
lung injury, and the role of radiation therapy in
David Alan Rizzieri
Professor of Medicine
My research interests focus on the care of patients with hematologic malignancies,
both with and without the use of bone marrow or stem cell transplantation. I focus
my research efforts on new approaches to manipulate minimal residual disease.Recent
endeavors have included:
Phase one trials with novel anti-cancer agents targeting aurora kinases, tyrosine
kinases, mtor, VEGF, and raf/ras pathways
New monoclonal antibodies targeting tumor stroma rat
Sarah Jo Stephens
Assistant Professor of Radiation Oncology
Samantha Thomas
Biostatistician, Principal
Samantha is the manager of the Duke Cancer Institute (DCI) Biostatistics Shared Resource.
Collaboratively, she primarily works with physicians in DCI, specifically in research
of Endocrine Neoplasia and Breast Cancer. She is also the director of the Biostatistics,
Epidemiology, Research, and Design Methods (BERD) Core Training and Internship Program
(BCTIP). Her professional experience involves study design, analysis, and reporting
of clinical trials and observational studies. Her specific areas
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