High dose total marrow irradiation (TMI) does not increase long-term toxicity of myeloablative fludarabine/busulfan (FluBu4) conditioning regimen in allogeneic hematopoietic stem cell transplantation (HSCT)

Lucas Maahs; Pritesh Patel; Matthew Koshy; Karen Sweiss; Zhengjia Chen; Ziqiao Xu; Bulent Aydogan; Damiano Rondelli

doi:10.1111/ejh.14195

High dose total marrow irradiation (TMI) does not increase long-term toxicity of myeloablative fludarabine/busulfan (FluBu4) conditioning regimen in allogeneic hematopoietic stem cell transplantation (HSCT)

Eur J Haematol. 2024 Apr 2. doi: 10.1111/ejh.14195. Online ahead of print.

Authors

Lucas Maahs¹, Pritesh Patel¹, Matthew Koshy^{2

3

4}, Karen Sweiss^{4

5}, Zhengjia Chen⁴, Ziqiao Xu⁴, Bulent Aydogan⁶, Damiano Rondelli^{1

4}

Affiliations

¹ Division of Hematology-Oncology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
² Department of Radiation Oncology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
³ Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA.
⁴ University of Illinois Cancer Center, Chicago, Illinois, USA.
⁵ College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.
⁶ Division of the Biological Sciences, University of Chicago, Chicago, Illinois, USA.

PMID: 38566462
DOI: 10.1111/ejh.14195

Abstract

Objectives: Based on a previous phase 1 study, total marrow irradiation (TMI) at 9Gy was added to a myeloablative FluBu4 conditioning regimen in allogeneic hematopoietic stem cell transplantation (HSCT) for myeloid malignancies. Here, we report on the long-term toxicity of TMI combined with FluBu4 and compare it to patients who received only FluBu4.

Methods: We retrospectively analyzed 38 consecutive patients conditioned with FluBu4/TMI (n = 15) or FluBu4 (n = 23, control group) who had at least 1 year follow-up post-transplant. The rate of long-term adverse events that have been previously associated with total body irradiation (TBI) was analyzed in the two groups.

Results: The baseline characteristics did not differ between the two groups. The control group had a longer median follow-up (71.2 mo) than the TMI group (38.5 mo) (p = .004). The most common adverse events were xerostomia, dental complications, cataracts, or osteopenia and did not differ between the two groups. Cognitive dysfunction or noninfectious pneumonitis, often detected after high dose TBI, were also not different in the two groups (p = .12 and p = .7, respectively). There was no grade 4 adverse event.

Conclusion: Our results suggest that a conditioning regimen with TMI 9Gy and FluBu4 does not increase long-term adverse events after allogeneic HSCT.

Keywords: allogeneic transplantation; bone marrow; busulfan; fludarabine; hematopoietic stem cell transplantation; long‐term adverse effects; radiotherapy.