Long-Term Toxicity after Non-Myeloablative Conditioning Regimens Using Total Body Irradiation.
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2025-04
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To evaluate long-term health risks after allogeneic hematopoietic stem cell transplantation (HSCT) using non-myeloablative total body irradiation (TBI).Methods and materials
All adult patients undergoing non-myeloablative allogeneic HSCT using TBI-based conditioning from 1995 to 2020 at our institution were included. Long-term toxicities, defined as events persisting beyond or occurring after 6 months from the date of transplant, were graded per the National Cancer Institute's Common Terminology Criteria for Adverse Events version 5.0. A competing risk analysis was performed to assess the risk of developing long-term toxicities within major organ systems using the Fine-Gray model. Outcomes were compared with a cohort of patients undergoing myeloablative TBI.Results
A total of 174 patients undergoing nonmyeloablative HSCT were assessed along with 378 myeloablative patients. Nonmyeloablative recipients were older (58 vs 43 years, P < .001), less likely to be transplanted for acute leukemia (35% vs 64%, P < .001), more likely to be transplanted for non-malignant conditions (33% vs 11%, P < .001), and were more likely to have used tobacco (33% vs 22%, P = .009). The median follow-up was 7.4 years. The cumulative incidences of long-term toxicities at 5 years for nonmyeloablative and myeloablative patients, taking into account the competing risk of death, were pulmonary (4% vs 4.8%, P > .9), cardiac (6.8% vs 3.3%, P = .11), renal (4.3% vs 4.1%, P = .9), thyroid (3.6% vs 1.5%, P = .2), other endocrine (3.1% vs 8.8%, P = .04), and cataracts (2.5% vs 2.8%, P = .7). The risk of developing a secondary malignancy was 3.5% vs 1.1% (P = .2) between the 2 cohorts. The proportion of all toxicities that were high-grade (3-5) for nonmyeloablative and myeloablative regimens, respectively, were pulmonary (60% and 69%), cardiac (17% and 45%), renal (27% and 21%), and other endocrine (4% and 2%).Conclusions
Recipients of nonmyeloablative conditioning regimens, despite receiving much lower doses of TBI and chemotherapy, are at risk of developing significant, long-term medical conditions comparable with those undergoing myeloablative HSCT.Type
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Patel, Pranalee, Zihan Wan, Mairead Dillon, Donna Niedzwiecki, Kerri-Anne Crowell, Mitchell E Horwitz, Edina Wang, Chris R Kelsey, et al. (2025). Long-Term Toxicity after Non-Myeloablative Conditioning Regimens Using Total Body Irradiation. Advances in radiation oncology, 10(4). p. 101738. 10.1016/j.adro.2025.101738 Retrieved from https://hdl.handle.net/10161/32991.
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Scholars@Duke

Mitchell Eric Horwitz
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.

Edina Wang
Clinical Research in Cancer Outcomes, Radiation Oncology Resident Education, Advances in Imaging, and Machine Learning Applications in Radiation Oncology

Christopher Ryan Kelsey
I specialize in the treatment of hematologic and thoracic malignancies. I have a special research interest in optimizing radiation therapy in lymphomas and leukemias, particularly consolidation radiation therapy in diffuse large B-cell lymphoma and total body irradiation in the setting of allogeneic stem cell transplantation. Other academic interests include cardiac toxicity after radiation therapy for lung cancer and optimizing stereotactic body radiation therapy for stage I non-small cell lung cancer.
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