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Impact of total body irradiation on successful neutrophil engraftment in unrelated bone marrow or cord blood transplantation.

Abstract：

:Total body irradiation (TBI) has been thought to promote donor cell engraftment in allogeneic hematopoietic cell transplantation (HCT) from alternative donors. However, recent progress in HCT strategies may affect the clinical significance of TBI on neutrophil engraftment. With the use of a Japanese transplant registry database, we analyzed 3933 adult recipients (>15 y.o.) who underwent HCT between 2006 and 2013 from an 8/8 HLA-matched unrelated bone marrow donor (MUD, n = 1367), an HLA-mismatched unrelated bone marrow donor (MMUD, n = 1102), or unrelated cord blood (CBT, n = 1464). Conditioning regimens were divided into five groups: High-TBI-(>8Gy), Low-TBI- (≤8Gy), and no-TBI-myeloablative conditioning (MAC), and Low-TBI- and no-TBI-reduced-intensity conditioning (RIC). In both MUD and MMUD, neutrophil engraftment rate was >90% in each of the five conditioning groups, and TBI was not associated with prompt neutrophil engraftment in multivariate analyses. Conversely, in CBT, TBI regimens had a higher rate of day-30 neutrophil engraftment than no-TBI-regimens: 78% in High-TBI-MAC, 83% in Low-TBI-MAC, and 76% in Low-TBI-RIC versus 65% in No-TBI-MAC, and 68% in No-TBI-RIC (P < .001). Multivariate analyses in CBT demonstrated that TBI-regimens were significantly associated with a higher rate of neutrophil engraftment. Subsequently focusing on CBT patients alone, TBI-regimens were significantly associated with a higher rate of neutrophil engraftment in patients who received CBT with a 4/6 or less HLA allele-match, or who had anti-HLA antibodies. In summary, TBI-regimens had no impact on neutrophil engraftment in the current practice of unrelated bone marrow transplantation. However, in CBT, TBI is still necessary to enhance engraftment.

journal_name

Am J Hematol

journal_title

American journal of hematology

authors

Nakasone H,Fuji S,Yakushijin K,Onizuka M,Shinohara A,Ohashi K,Miyamura K,Uchida N,Takanashi M,Ichinohe T,Atsuta Y,Fukuda T,Ogata M,Complication Working Group of Japanese Society for Hematopoietic Cell Transplantation.

doi

10.1002/ajh.24613

subject

Has Abstract

pub_date

2017-02-01 00:00:00

pages

171-178

issue

eissn

0361-8609

issn

1096-8652

journal_volume

pub_type

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Impact of total body irradiation on successful neutrophil engraftment in unrelated bone marrow or cord blood transplantation.