1
|
Takahashi T, Lake AJ, Wachter F, Calderon FA, Dandoy C, Keating AK. Effects of Total Body Irradiation on Hematopoietic Cell Transplantation Outcomes in Pediatric Acute Myeloid Leukemia with Prior Central Nervous System Involvement. Transplant Cell Ther 2024; 30:812.e1-812.e11. [PMID: 38763417 DOI: 10.1016/j.jtct.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
The implications of previous central nervous system (CNS) involvement in children with acute myeloid leukemia (AML) undergoing hematopoietic cell transplantation (HCT) remain inadequately understood. Patients with CNS disease require more upfront CNS-directed intrathecal therapy, but little is known about whether transplant conditioning regimens should be intensified or if previous CNS involvement impacts post-HCT outcomes. While total body irradiation (TBI) remains standard for pediatric acute lymphoblastic leukemia myeloablative conditioning, it has been largely replaced with chemotherapy-only myeloablation in pediatric AML, primarily due to toxicity and late effects associated with TBI. In the setting of previous CNS involvement, it has been suggested that TBI-based myeloablation may have advantages due to superior CNS tissue penetration and thus decreased rates of AML relapse post-HCT. We analyzed a publicly available dataset derived from the Center for International Blood and Marrow Transplantation Research (CIBMTR) registry to characterize the impact of TBI in HCT preparative regimens in pediatric AML patients with a history of CNS involvement. The study dataset was obtained from the CIBMTR data repository. The study cohort included patients aged ≤21 years who underwent initial allogeneic HCT with myeloablative conditioning for de novo AML in the first or second complete remission (CR) between 2008 and 2016, who provided consent for research. Patients with mismatched related donor transplants and noncalcineurin inhibitor graft-versus-host disease (GVHD) prophylaxis were excluded. The dataset was further modified by excluding patients with missing disease site data or those with non-CNS extramedullary disease. Patients were categorized as CNS-positive or -negative AML (AML-CNS(+) and AML-CNS(-), respectively) based on the disease status at diagnosis. The Cox regression model and Fine-Grey methods were employed to delineate the effects of TBI and CNS disease on key HCT outcomes. The study cohort comprised 550 pediatric AML patients, of which 25% (n = 136) were AML-CNS(+). CNS involvement was more prevalent in patients aged 0 to 3 years, patients who were in the second CR, and those with a mismatched unrelated donor or umbilical cord blood. AML-CNS(+) patients demonstrated a lower relapse rate (hazard ratio: 0.50, 95% confidence interval: 0.33 to 0.76) compared to AML-CNS(-) patients, with comparable disease-free survival (DFS) and overall survival (OS) (P = .10 and 0.20, respectively) in the two cohorts. The entire TBI-treated cohort showed an association with increased risks of grade 2 to 4 acute GVHD, bloodstream infections, and endocrine dysfunction. TBI use within the AML-CNS(+) cohort was associated with a lower relapse rate but increased risks of nonrelapse mortality and a trend of higher grade 3 to 4 acute GVHD. In this population-based analysis of pediatric patients with de novo AML undergoing HCT, TBI-based conditioning regimens did not confer an advantage in DFS or OS compared to non-TBI regimens, irrespective of CNS disease status. However, TBI use was associated with increased risks of short- and long-term comorbidities. These findings underscore the need for careful consideration of TBI in pediatric AML.
Collapse
Affiliation(s)
- Takuto Takahashi
- Pediatric Stem Cell Transplant, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Alexander J Lake
- Pediatric Stem Cell Transplant, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Franziska Wachter
- Pediatric Stem Cell Transplant, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Francesca Alvarez Calderon
- Pediatric Stem Cell Transplant, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christopher Dandoy
- Pediatric Stem Cell Transplant, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amy K Keating
- Pediatric Stem Cell Transplant, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
2
|
Maahs L, Patel P, Koshy M, Sweiss K, Chen Z, Xu Z, Aydogan B, Rondelli D. 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; 113:110-116. [PMID: 38566462 DOI: 10.1111/ejh.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
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.
Collapse
Affiliation(s)
- Lucas Maahs
- Division of Hematology-Oncology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pritesh Patel
- Division of Hematology-Oncology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Matthew Koshy
- Department of Radiation Oncology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Karen Sweiss
- University of Illinois Cancer Center, Chicago, Illinois, USA
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Zhengjia Chen
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Ziqiao Xu
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Bulent Aydogan
- Division of the Biological Sciences, University of Chicago, Chicago, Illinois, USA
| | - Damiano Rondelli
- Division of Hematology-Oncology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- University of Illinois Cancer Center, Chicago, Illinois, USA
| |
Collapse
|
3
|
Kwon M, Kim BS, Yoon S, Oh SO, Lee D. Hematopoietic Stem Cells and Their Niche in Bone Marrow. Int J Mol Sci 2024; 25:6837. [PMID: 38999948 PMCID: PMC11241602 DOI: 10.3390/ijms25136837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Extensive research has explored the functional correlation between stem cells and progenitor cells, particularly in blood. Hematopoietic stem cells (HSCs) can self-renew and regenerate tissues within the bone marrow, while stromal cells regulate tissue function. Recent studies have validated the role of mammalian stem cells within specific environments, providing initial empirical proof of this functional phenomenon. The interaction between bone and blood has always been vital to the function of the human body. It was initially proposed that during evolution, mammalian stem cells formed a complex relationship with the surrounding microenvironment, known as the niche. Researchers are currently debating the significance of molecular-level data to identify individual stromal cell types due to incomplete stromal cell mapping. Obtaining these data can help determine the specific activities of HSCs in bone marrow. This review summarizes key topics from previous studies on HSCs and their environment, discussing current and developing concepts related to HSCs and their niche in the bone marrow.
Collapse
Affiliation(s)
- Munju Kwon
- Department of Convergence Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Byoung Soo Kim
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan 50612, Republic of Korea
| | - Sik Yoon
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Sae-Ock Oh
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Dongjun Lee
- Department of Convergence Medicine, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
- Transplantation Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
| |
Collapse
|
4
|
Webster M, Dona Lemus OM, Zheng D, Wancura JN, Tanny S, Sakthivel G, Constine L. Case study with dosimetric analysis: Total body irradiation to a patient with a left ventricular assist device. Clin Case Rep 2024; 12:e8868. [PMID: 38756618 PMCID: PMC11096280 DOI: 10.1002/ccr3.8868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Key Clinical Message A patient presented with cardiogenic shock, requiring the implantation of a left ventricular assist device (LVAD), and acute myeloblastic leukemia. This necessitated total body irradiation (TBI) while balancing dose reduction to the LVAD components to avoid potential radiation damage. Here we outline our treatment approach and dose estimates to the LVAD. Abstract This case report discusses the delivery of TBI to a patient with an LVAD. This treatment required radiation-dose determinations and consequential reductions for the heart, LVAD, and an external controller connected to the LVAD. The patient was treated using a traditional 16MV anterior posterior (AP)/posterior anterior (PA) technique at a source-to-surface-distance of 515 cm for 400 cGy in two fractions. A 3 cm thick Cerrobend block was placed on the beam spoiler to reduce dose to the heart and LVAD to 150 cGy. The external controller was placed in a 1 cm thick acrylic box to reduce neutron dose and positioned as far from the treatment fields as achievable. In vivo measurements were made using optically stimulated luminescence dosimeters (OSLDs) placed inside the box at distances of 2 cm, 8.5 cm, and 14 cm from the field edge, and on the patient along the central axis and centered behind the LVAD block. Further ion chamber measurements were made using a solid water phantom to more accurately estimate the dose delivered to the LVAD. Neutron dose measurements were also conducted. The total estimated dose to the controller ranged from 135.3 cGy to 91.5 cGy. The LVAD block reduced the surface dose to the patient to 271.6 cGy (68.1%). The block transmission factors of the 3 cm Cerrobend block measured in the phantom were 45% at 1 cm depth and decreased asymptotically to around 30% at 3 cm depth. Applying these transmission factors to the in vivo measurements yielded a dose of 120 cGy to the implanted device. The neutron dose the LVAD region is estimated around 0.46 cGy. Physical limitations of the controller made it impossible to completely avoid dose. Shielding is recommended. The block had limited dose reduction to the surface, due to secondary particles, but appropriately reduced the dose at 3 cm and beyond. More research on LVADs dose limits would be beneficial.
Collapse
Affiliation(s)
- Matthew Webster
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Olga M. Dona Lemus
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Dandan Zheng
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Joshua N. Wancura
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sean Tanny
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Gukan Sakthivel
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Louis Constine
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| |
Collapse
|
5
|
Echecopar C, Del Val Rey I, Galán-Gómez V, González-Pérez C, Mozo Del Castillo Y, González Martínez B, Pérez-Martínez A. The paradigm of total body irradiation in acute lymphoblastic leukaemia: Therapeutic effectiveness versus the challenges of toxicity. An Pediatr (Barc) 2024; 100:259-267. [PMID: 38548564 DOI: 10.1016/j.anpede.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/18/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Total body irradiation (TBI) is part of the myeloablative conditioning for hematopoietic stem cell transplantation (HSCT) in malignant hematologic disorders. This therapy has recently shown improved survival in acute lymphoblastic leukemia (ALL) compared to chemotherapy-based regimens. However, side effects are a significant limitation, especially in the pediatric population. PATIENTS AND METHODS We retrospectively analyzed the survival of patients with ALL who underwent an HSCT at a tertiary hospital between 1996 and 2009 (N = 69 HSCT in 57 patients). We differentiated a cohort that received TBI (N = 44) from another that did not (N = 25). Subsequently, we interviewed the survivors from the TBI group with a minimum of 10 years of follow-up (N = 18), asking about the presence of side effects. RESULTS The overall survival (OS) at 2 and 5 years was 79.1% and 65.2% respectively for the TBI group and 66.2% and 55.8% for the non-TBI group, although this difference was not significant (P=.31). The event-free survival (EFS) at 2 and 5 years was 77.3% and 63.6% respectively for the TBI group and 56% and 32% for the non-TBI group (P=.02). The probability of relapse (PR) at 2 years for those who received TBI was 10% compared to 28.6% for those who did not receive TBI (P=.005). Survivors who received TBI developed secondary neoplasms (39%), dyslipidemia (67%), cognitive impairments affecting memory (44%), recurrent respiratory infections (39%), thyroid abnormalities (45%), premature ovarian failure (89%), cataracts (22%), and psychological problems (44%). However, the quality of life, as self-assessed by the patients, was considered good for 83% of the participants.. CONCLUSIONS Patients who received TBI had significantly higher EFS and lower PR. However, adverse effects are frequent and significant, although they do not subjectively affect quality of life.
Collapse
Affiliation(s)
- Carlos Echecopar
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Víctor Galán-Gómez
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos González-Pérez
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Berta González Martínez
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Pérez-Martínez
- Servicio de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
| |
Collapse
|
6
|
Melton MK, Stanley DN, Iqbal Z, Keene KS, Simiele E, McDonald A. Acute Toxicity of Total Body Irradiation Using Volumetric Arc Therapy With a Focus on the Effect of Lung Dose Rate. Adv Radiat Oncol 2024; 9:101430. [PMID: 38406392 PMCID: PMC10882112 DOI: 10.1016/j.adro.2023.101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/27/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose To report adverse effects of high dose total body irradiation (TBI) delivered using a volumetric arc therapy (VMAT) technique and to assess pulmonary toxicity at dose rates of 40 and 100 monitor units per minute (MU/min). Methods and Materials This retrospective study included patients >18 years old who received ≥8 Gy TBI using a VMAT technique. The TBI dose was prescribed to a planning target volume consisting of a 0.5 cm retraction of the body with the lungs subtracted. The objective function specified planning target volume coverage goals of D100% ≥ 90% and Dmax <130%. A lung dose control structure consisting of a 1 cm retraction of the lung volume was limited to Dmean <75%. Treatments were initially delivered with a dose rate of 40 MU/min for the thoracic isocenters and 100 MU/min for the other isocenters. Beginning in January 2021, a dose rate of 100 MU/min was used for all isocenters. All treatments were administered in 2 Gy fractions delivered twice daily. Acute toxicity was assessed for 30 days after TBI. Results A total of 29 patients were included in this analysis who received TBI between January 2019 and October 2021. Prescription dose ranged from 8 to 12 Gy. Mean lung dose was 7.9 Gy (SD, 1.4 Gy) for patients treated at 40 MU/min and for patients treated at 100 MU/min 7.1 Gy (SD, 1.3 Gy). Mucositis was the most common grade 3 toxicity and occurred in 10 (34%) patients. Only 1 instance of pneumonitis was observed and occurred in a patient who received a mean lung dose of 10.1 Gy delivered at 40 MU/min. Conclusions In this cohort of patients who received high dose TBI using a VMAT technique, the composite rate of acute toxicity was not unexpectedly high. We did not observe an increase in lung toxicity after increasing the dose rate of the thoracic isocenters from 40 MU/min to 100 MU/min.
Collapse
Affiliation(s)
- Michael Kole Melton
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Dennis N. Stanley
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Zohaib Iqbal
- Department of Radiation Oncology, The University of Texas Southwestern, Dallas, Texas
| | - Kimberly S. Keene
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric Simiele
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew McDonald
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
7
|
Hering H, Effeney B, Brady C, Hargrave C. An evaluation of ankle and foot bolus in paediatric modulated arc total body irradiation (MATBI). J Med Radiat Sci 2024. [PMID: 38468597 DOI: 10.1002/jmrs.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION This retrospective planning study aimed to evaluate the role of bolus in achieving dose uniformity in the ankles and feet in paediatric patients undergoing Modulated Arc Total Body Irradiation (MATBI) treatment and to identify patient factors that may negate or warrant its use. METHODS The clinically treated plans of 20 paediatric patients who received MATBI treatment utilising ankle and foot bolus (Bolus plan) were compared with two retrospectively generated plans; a plan with bolus removed and no re-optimisation (No Bolus plan), and a re-optimised plan without bolus attempting to achieve equal dosimetry to the clinical plan via monitor unit adjustment (MU plan). Descriptive statistics were used to evaluate the dose uniformity criteria of ±10% coverage of the reference dose (RD) for each subregion of the ankle and foot for the three plans. The impact of patient height, weight, and age at the time of treatment was evaluated using Spearman's correlation. RESULTS Variation in doses >10% RD was minimal across the three plans, with an average D1cc difference < 0.4Gy. For the ankle and foot regions in the Bolus plans, the volume receiving at least 90% of the RD (V90) was on average > 92%. In No Bolus and MU plans, there was an average reduction of 24.5% and 23.2% V90 coverage respectively in the toes. Spearman's correlation suggests height has the strongest relationship to D1cc. CONCLUSION This study validated the continued use of ankle and foot bolus to achieve dosimetric goals for paediatric MATBI treatments, particularly V90 coverage across all heights.
Collapse
Affiliation(s)
- Hannah Hering
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- Radiation Oncology Princess Alexandra Hospital-Raymond Terrace, Metro South Health Service, South Brisbane, Queensland, Australia
| | - Beth Effeney
- Radiation Oncology Princess Alexandra Hospital-Raymond Terrace, Metro South Health Service, South Brisbane, Queensland, Australia
| | - Carole Brady
- Radiation Oncology Princess Alexandra Hospital-Raymond Terrace, Metro South Health Service, South Brisbane, Queensland, Australia
| | - Catriona Hargrave
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- Radiation Oncology Princess Alexandra Hospital-Raymond Terrace, Metro South Health Service, South Brisbane, Queensland, Australia
| |
Collapse
|
8
|
Parwani KK, Branella GM, Burnham RE, Burnham AJ, Bustamante AYS, Foppiani EM, Knight KA, Petrich BG, Horwitz EM, Doering CB, Spencer HT. Directing the migration of serum-free, ex vivo-expanded Vγ9Vδ2 T cells. Front Immunol 2024; 15:1331322. [PMID: 38487542 PMCID: PMC10937339 DOI: 10.3389/fimmu.2024.1331322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Vγ9Vδ2 T cells represent a promising cancer therapy platform because the implementation of allogenic, off-the-shelf product candidates is possible. However, intravenous administration of human Vγ9Vδ2 T cells manufactured under good manufacturing practice (GMP)-compliant, serum-free conditions are not tested easily in most mouse models, mainly because they lack the ability to migrate from the blood to tissues or tumors. We demonstrate that these T cells do not migrate from the circulation to the mouse bone marrow (BM), the site of many malignancies. Thus, there is a need to better characterize human γδ T-cell migration in vivo and develop strategies to direct these cells to in vivo sites of therapeutic interest. To better understand the migration of these cells and possibly influence their migration, NSG mice were conditioned with agents to clear BM cellular compartments, i.e., busulfan or total body irradiation (TBI), or promote T-cell migration to inflamed BM, i.e., incomplete Freund's adjuvant (IFA), prior to administering γδ T cells. Conditioning with TBI, unlike busulfan or IFA, increases the percentage and number of γδ T cells accumulating in the mouse BM, and cells in the peripheral blood (PB) and BM display identical surface protein profiles. To better understand the mechanism by which cells migrate to the BM, mice were conditioned with TBI and administered γδ T cells or tracker-stained red blood cells. The mechanism by which γδ T cells enter the BM after radiation is passive migration from the circulation, not homing. We tested if these ex vivo-expanded cells can migrate based on chemokine expression patterns and showed that it is possible to initiate homing by utilizing highly expressed chemokine receptors on the expanded γδ T cells. γδ T cells highly express CCR2, which provides chemokine attraction to C-C motif chemokine ligand 2 (CCL2)-expressing cells. IFNγ-primed mesenchymal stromal cells (MSCs) (γMSCs) express CCL2, and we developed in vitro and in vivo models to test γδ T-cell homing to CCL2-expressing cells. Using an established neuroblastoma NSG mouse model, we show that intratumorally-injected γMSCs increase the homing of γδ T cells to this tumor. These studies provide insight into the migration of serum-free, ex vivo-expanded Vγ9Vδ2 T cells in NSG mice, which is critical to understanding the fundamental properties of these cells.
Collapse
Affiliation(s)
- Kiran K Parwani
- Cancer Biology Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Gianna M Branella
- Cancer Biology Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Rebecca E Burnham
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andre J Burnham
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Austre Y Schiaffino Bustamante
- Cancer Biology Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Elisabetta Manuela Foppiani
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Kristopher A Knight
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | - Edwin M Horwitz
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Christopher B Doering
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - H Trent Spencer
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| |
Collapse
|
9
|
Dogliotti I, Levis M, Martin A, Bartoncini S, Felicetti F, Cavallin C, Maffini E, Cerrano M, Bruno B, Ricardi U, Giaccone L. Maintain Efficacy and Spare Toxicity: Traditional and New Radiation-Based Conditioning Regimens in Hematopoietic Stem Cell Transplantation. Cancers (Basel) 2024; 16:865. [PMID: 38473227 DOI: 10.3390/cancers16050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Novelty in total body irradiation (TBI) as part of pre-transplant conditioning regimens lacked until recently, despite the developments in the field of allogeneic stem cell transplants. Long-term toxicities have been one of the major concerns associated with TBI in this setting, although the impact of TBI is not so easy to discriminate from that of chemotherapy, especially in the adult population. More recently, lower-intensity TBI and different approaches to irradiation (namely, total marrow irradiation, TMI, and total marrow and lymphoid irradiation, TMLI) were implemented to keep the benefits of irradiation and limit potential harm. TMI/TMLI is an alternative to TBI that delivers more selective irradiation, with healthy tissues being better spared and the control of the radiation dose delivery. In this review, we discussed the potential radiation-associated long-term toxicities and their management, summarized the evidence regarding the current indications of traditional TBI, and focused on the technological advances in radiotherapy that have resulted in the development of TMLI. Finally, considering the most recent published trials, we postulate how the role of radiotherapy in the setting of allografting might change in the future.
Collapse
Affiliation(s)
- Irene Dogliotti
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Mario Levis
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Aurora Martin
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Sara Bartoncini
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Francesco Felicetti
- Division of Oncological Endocrinology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", 10126 Torino, Italy
| | - Chiara Cavallin
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Enrico Maffini
- Hematology Institute "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marco Cerrano
- Division of Hematology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", 10126 Torino, Italy
| | - Benedetto Bruno
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Umberto Ricardi
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Luisa Giaccone
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| |
Collapse
|
10
|
Dreher N, Dörrler AL, Kraus S, Higuchi T, Serfling SE, Samnick S, Einsele H, Grigoleit GU, Buck AK, Werner RA. C-X-C Motif Chemokine Receptor 4-Targeted Radioligand Therapy in Hematological Malignancies-Myeloablative Effects, Antilymphoma Activity, and Safety Profile. Clin Nucl Med 2024; 49:146-151. [PMID: 38081189 DOI: 10.1097/rlu.0000000000004974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND After C-X-C motif chemokine receptor 4 (CXCR4)-directed radioligand therapy (RLT), lymphoma patients are scheduled for conditioning therapy (CON) followed by hematopoietic stem cell transplantation (HSCT). We aimed to determine whether CXCR4-RLT can achieve bone marrow ablation and direct antilymphoma activity independent from CON/HSCT and also evaluated the safety profile of this theranostic approach in an acute setting. PATIENTS AND METHODS After CXCR4-directed 68 Ga-pentixafor PET/CT, 21 heavily pretreated patients with hematological malignancies underwent CXCR4-directed RLT using 90 Y-pentixather. The extent of myeloablative efficacy was determined by investigating hematologic laboratory parameters before RLT (day -1), at the day of RLT (day 0), 2 days after RLT (day 2), and before CON (median day 10). Serving as surrogate marker of antilymphoma activity, lactate dehydrogenase (LDH) levels were also assessed until CON. We also screened for laboratory-defined tumor lysis syndrome after the Cairo-Bishop definition and recorded acute laboratory adverse events using the Common Terminology Criteria for Adverse Events version 5.0. RESULTS After RLT, we observed a significant decline of leukocyte levels by 79.4% ± 18.7% till CON (granulocytes, drop by 70.3% ± 21%; platelets, reduction by 43.1% ± 36%; P ≤ 0.0005 vs day 0, respectively). After RLT, LDH levels already reached a peak at day 2, which was followed by a rapid decline thereafter (peak vs day of CON, P = 0.0006), indicating that 90 Y-pentixather exhibits direct antilymphoma activity. At day of CON, LDH levels were also significantly lower when compared with day -1 ( P = 0.04), suggestive for durable response mediated by RLT. No patient fulfilled the criteria of tumor lysis syndrome, whereas 25 laboratory adverse events attributable to CXCR4-directed treatment were identified (≥grade 3 in 2/25 [8%]). During further treatment course, all patients (100%) received HSCT. CONCLUSIONS CXCR4-directed RLT causes effective myeloablation, which allows for HSCT. In addition, it also exerts direct antilymphoma activity independent of subsequent therapeutic steps, whereas safety profile was acceptable.
Collapse
Affiliation(s)
| | | | - Sabrina Kraus
- Division of Hematology and Oncology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg
| | | | | | | | - Hermann Einsele
- Division of Hematology and Oncology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg
| | | | | | | |
Collapse
|
11
|
Cortiula F, Hendriks LEL, Wijsman R, Houben R, Steens M, Debakker S, Canters R, Trovò M, Sijtsema NM, Niezink AGH, Unipan M, Urban S, Michelotti A, Dursun S, Bootsma G, Hattu D, Nuyttens JJ, Moretti E, Taasti VT, De Ruysscher D. Proton and photon radiotherapy in stage III NSCLC: Effects on hematological toxicity and adjuvant immune therapy. Radiother Oncol 2024; 190:110019. [PMID: 38000689 DOI: 10.1016/j.radonc.2023.110019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND PURPOSE Concurrent chemo-radiotherapy (CCRT) followed by adjuvant durvalumab is standard-of-care for fit patients with unresectable stage III NSCLC. Intensity modulated proton therapy (IMPT) results in different doses to organs than intensity modulated photon therapy (IMRT). We investigated whether IMPT compared to IMRT reduce hematological toxicity and whether it affects durvalumab treatment. MATERIALS AND METHODS Prospectively collected series of consecutive patients with stage III NSCLC receiving CCRT between 06.16 and 12.22 (staged with FDG-PET-CT and brain imaging) were retrospectively analyzed. The primary endpoint was the incidence of lymphopenia grade ≥ 3 in IMPT vs IMRT treated patients. RESULTS 271 patients were enrolled (IMPT: n = 71, IMRT: n = 200) in four centers. All patients received platinum-based chemotherapy. Median age: 66 years, 58 % were male, 36 % had squamous NSCLC. The incidence of lymphopenia grade ≥ 3 during CCRT was 67 % and 47 % in the IMRT and IMPT group, respectively (OR 2.2, 95 % CI: 1.0-4.9, P = 0.03). The incidence of anemia grade ≥ 3 during CCRT was 26 % and 9 % in the IMRT and IMPT group respectively (OR = 4.9, 95 % CI: 1.9-12.6, P = 0.001). IMPT was associated with a lower rate of Performance Status (PS) ≥ 2 at day 21 and 42 after CCRT (13 % vs. 26 %, P = 0.04, and 24 % vs. 39 %, P = 0.02). Patients treated with IMPT had a higher probability of receiving adjuvant durvalumab (74 % vs. 52 %, OR 0.35, 95 % CI: 0.16-0.79, P = 0.01). CONCLUSION IMPT was associated with a lower incidence of severe lymphopenia and anemia, better PS after CCRT and a higher probability of receiving adjuvant durvalumab.
Collapse
Affiliation(s)
- Francesco Cortiula
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Medical Oncology, University Hospital of Udine, Udine, Italy.
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Robin Wijsman
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruud Houben
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Michelle Steens
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Sarah Debakker
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Richard Canters
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marco Trovò
- Department of Radiation Oncology, University Hospital of Udine, Udine, Italy
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne G H Niezink
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mirko Unipan
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Susanna Urban
- Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Anna Michelotti
- Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Safiye Dursun
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Gerben Bootsma
- Department of Pulmonary Diseases, Zuyderland Medical Centre, the Netherlands
| | - Djoya Hattu
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Joost J Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Eugenia Moretti
- Medical Physics Unit, University Hospital of Udine, Udine, Italy
| | - Vicki T Taasti
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| |
Collapse
|
12
|
Goyal A, Foss F. Allogeneic transplantation and cellular therapies in cutaneous T-cell lymphoma. Expert Rev Anticancer Ther 2024; 24:41-58. [PMID: 38224371 DOI: 10.1080/14737140.2024.2305356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Mycosis fungoides (MF) and Sezary syndrome (SS) are the most common types of cutaneous T-cell lymphoma. Although many available treatments offer temporary disease control, allogeneic hematopoietic stem cell transplant (allo-HSCT) is the only curative treatment option for advanced stage MF and SS. CAR T-cell therapy is a promising new avenue for treatment. AREAS COVERED In this review, we discuss the evidence supporting the use of allo-HSCT for the treatment of MF/SS, including disease status at the time of transplant, conditioning regimen, total body irradiation (TBI), and donor lymphocyte infusion (DLI). We also address the potential role for CAR T-cell therapy in CTCL. EXPERT OPINION Allo-HSCT is an effective treatment for patients with advanced MF and SS. However, significant research is required to determine optimal treatment protocols. Data support the use of reduced-intensity conditioning regimens and suggests that the use of TBI for debulking of skin disease may result in more durable remissions. Donor lymphocyte infusions (DLI) appear to be particularly effective in inducing complete remission in MF/SS patients with relapsed or residual disease. Challenges with CAR-T therapies in T-cell lymphoma include T-cell fratricide due to shared antigens on malignant and nonmalignant T-cells, penetrance into the skin compartment, and CAR-T cell persistence.
Collapse
Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Francine Foss
- Department of Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
13
|
Smith J, Toto R, Moro C. The effects of radiation on myeloid lineage immune cells within the rodent urinary bladder: a systematic review. Int Urol Nephrol 2023; 55:3005-3014. [PMID: 37620625 PMCID: PMC10611598 DOI: 10.1007/s11255-023-03748-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Radiotherapy is a prominent therapy for many malignant and non-malignant disorders, though it can cause side effects such as radiation-induced cystitis. Current research has highlighted a role for mast cells and macrophages in the prognosis of such radiation-induced toxicities. However, the prognostic value of these immune cells in the pathophysiology of radiation-induced cystitis is not clear. As such, a systematic review was conducted to assess myeloid-lineage immune cells for their prognostic value in radiation-induced cystitis to address this gap in literature. METHODS The protocol was registered in PROSPERO, and searches were performed in PubMed, Embase and Web of Science databases for pre-clinical rodent studies on radiation-induced cystitis. RESULTS After de-duplication, 153 articles were screened for relevancy by title and abstract. Title and abstract screening deemed 64 studies irrelevant. The remaining 85 studies were full-text screened, yielding seven unique articles for data extraction. Most included studies had an unclear risk of bias. The findings of this systematic review suggest that the prognostic value of myeloid-lineage immune cells in radiation-induced cystitis is still unclear, indicating a need for further research in this field. CONCLUSION Although the studies reviewed provide some insight into the role of these immune cells in disease pathology, the limited number of studies and unclear risk of bias further highlights a need for additional, high-quality research in this area. In summary, this systematic review highlights a need to understand the involvement of immune cells in radiation-induced cystitis pathophysiology and lay the groundwork for further research in this area. TRIAL REGISTRATION PROSPERO registration: CRD42022345960.
Collapse
Affiliation(s)
- Jessica Smith
- Faculty of Health Sciences and Medicine, Bond University, Queensland, 4226, Australia
| | - Rimaz Toto
- Faculty of Health Sciences and Medicine, Bond University, Queensland, 4226, Australia
| | - Christian Moro
- Faculty of Health Sciences and Medicine, Bond University, Queensland, 4226, Australia.
| |
Collapse
|
14
|
Köksal M, Baumert J, Jazmati D, Schoroth F, Garbe S, Koch D, Scafa D, Sarria GR, Leitzen C, Massoth G, Delis A, Heine A, Holderried T, Brossart P, Müdder T, Schmeel LC. Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics. J Cancer Res Clin Oncol 2023; 149:7007-7015. [PMID: 36856852 PMCID: PMC10374741 DOI: 10.1007/s00432-023-04657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Intensity-modulated helical tomotherapy (HT) is a promising technique in preparation for bone marrow transplantation. Nevertheless, radiation-sensitive organs can be substantially compromised due to suboptimal delivery techniques of total body irradiation (TBI). To reduce the potential burden of radiation toxicity to organs at risk (OAR), high-quality coverage and homogeneity are essential. We investigated dosimetric data from kidney, lung and thorax, liver, and spleen in relation to peripheral blood kinetics. To further advance intensity-modulated total body irradiation (TBI), the potential for dose reduction to lung and kidney was considered in the analysis. PATIENTS AND METHODS 46 patients undergoing TBI were included in this analysis, partially divided into dose groups (2, 4, 8, and 12 Gy). HT was performed using a rotating gantry to ensuring optimal reduction of radiation to the lungs and kidneys and to provide optimal coverage of other OAR. Common dosimetric parameters, such as D05, D95, and D50, were calculated and analysed. Leukocytes, neutrophils, platelets, creatinine, GFR, haemoglobin, overall survival, and graft-versus-host disease were related to the dosimetric evaluation using statistical tests. RESULTS The mean D95 of the lung is 48.23%, less than half the prescribed and unreduced dose. The D95 of the chest is almost twice as high at 84.95%. Overall liver coverage values ranged from 96.79% for D95 to 107% for D05. The average dose sparing of all patients analysed resulted in an average D95 of 68.64% in the right kidney and 69.31% in the left kidney. Average D95 in the spleen was 94.28% and D05 was 107.05%. Homogeneity indexes ranged from 1.12 for liver to 2.28 for lung. The additional significance analyses conducted on these blood kinetics showed a significant difference between the 2 Gray group and the other three groups for leukocyte counts. Further statistical comparisons of the dose groups showed no significant differences. However, there were significant changes in the dose of OAR prescribed with dose sparing (e.g., lung vs. rib and kidney). CONCLUSION Using intensity-modulated helical tomotherapy to deliver TBI is a feasible method in preparation for haematopoietic stem cell transplantation. Significant dose sparing in radiosensitive organs such as the lungs and kidneys is achievable with good overall quality of coverage. Peripheral blood kinetics support the positive impact of HT and its advantages strongly encourage its implementation within clinical routine.
Collapse
Affiliation(s)
- Mümtaz Köksal
- Radiation Oncology, University Hospital Bonn, Bonn, Germany.
| | | | - Danny Jazmati
- Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Felix Schoroth
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Davide Scafa
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | | | - Gregor Massoth
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Achilles Delis
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Annkristin Heine
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Tobias Holderried
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Thomas Müdder
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | |
Collapse
|
15
|
Arias-Espinosa L, Acosta-Medina AA, Vargas-España A, Fuentes-Martin V, Colunga-Pedraza PR, Hawing-Zarate JA, Leon AGD, Soto-Mota A, Pacheco-Gutierrez G, Vargas-Serafín C, Barrera-Lumbreras G, Bourlon C. Acute Leukemia Relapse after Hematopoietic Stem Cell Transplantation: The Good, the Bad, and the Ugly of Isolated Extramedullary Relapse in a Latin American Population. Transplant Cell Ther 2023; 29:510.e1-510.e9. [PMID: 37169289 DOI: 10.1016/j.jtct.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) is an effective therapy for acute leukemia (AL). Relapse represents the main cause of mortality. Isolated extramedullary relapse (iEMR) is atypical and has been related to better outcomes. Here we describe the clinical characteristics and outcomes of AL relapse after HSCT in our study population and analyze the impacts of different types of relapse on survival outcomes. This retrospective, multicenter study included 124 patients age ≥15 years with AL who underwent HSCT between 2004 and 2019. At diagnosis, 66.1% of the patients had lymphocytic AL, 19.7% presented with high-risk features, and 18.5% had extramedullary disease (EMD). At HSCT, 83.1% of the patients were in complete remission (CR), and 44.8% had negative measurable residual disease (MRD). The vast majority of donors were related (96%), including 48.4% HLA-matched and 47.6% haploidentical. Myeloablative conditioning was provided to 80.6% of patients. The median overall survival (OS) was 15 months (95% confidence interval [CI] 9.9 to 20.1 months). Factors associated with improved OS were adolescent and young adult (AYA) patient (P = .035), first or second CR (P = .026), and chronic graft-versus-host disease (GVHD) (P < .001). Acute GVHD grade III-IV (P = .009) was associated with increased mortality. The median relapse-free survival was 13 months (95% CI, 7.17 to 18.8 months); early disease status (P = .017) and chronic GVHD (P < .001) had protective roles. Sixty-eight patients (55%) relapsed after HSCT, with a median time to relapse of 6 months (95% CI, 3.6 to 8.4 months). iEMR was reported in 16 patients (23.5%). The most commonly involved extramedullary sites were the central nervous system and skin. Compared to patients with bone marrow relapse, all patients with iEMR had a diagnosis of acute lymphoid leukemia (P = .008), and 93.8% belonged to the AYA group; regarding pre-HSCT characteristics, iEMR patients had higher rates of negative MRD (P = .06) and a history of EMD (P = .009). Seventy-seven percent of relapsed patients received additional treatment with curative intent. The median OS after relapse (OSr) was 4 months (95% CI, 2.6 to 5.4 months). Factors related to increased OSr included lymphoid phenotype (P = .03), iEMR (P = .0042), late relapse (≥6 months) (P = .014), receipt of systemic therapy including second HSCT (P < .001), and response to therapy (P < .001). Rates of relapse and iEMR were higher than those previously reported in other studies. Advanced disease, reduced-intensity conditioning, and a diminished graft-versus-leukemia effect were factors influencing these findings. At relapse, presenting with iEMR after 6 months and receiving intensive therapy with adequate response were associated with better outcomes. Our results strongly suggest that a personalized approach to treating patients with HSCT is needed to counterbalance specific adverse factors and can positively impact clinical outcomes.
Collapse
Affiliation(s)
- Luis Arias-Espinosa
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Aldo A Acosta-Medina
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Andres Vargas-España
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Valerie Fuentes-Martin
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Perla R Colunga-Pedraza
- Department of Hematology, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Mexico
| | - Jose Angel Hawing-Zarate
- Department of Hematology, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Mexico
| | - Andres Gómez-De Leon
- Department of Hematology, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Mexico
| | - Adrian Soto-Mota
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; School of Medical Sciences, Monterrey Institute of Technology and Higher Education, Mexico City, Mexico
| | - Guillermo Pacheco-Gutierrez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Cesar Vargas-Serafín
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Georgina Barrera-Lumbreras
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Christianne Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
| |
Collapse
|
16
|
Frederick R, Van Dyke L, Hudson A, Pierce G. Advanced automated treatment planning for total body irradiation: Implementation and effects on standardization. Phys Med 2023; 112:102623. [PMID: 37356420 DOI: 10.1016/j.ejmp.2023.102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 06/27/2023] Open
Abstract
PURPOSE This work describes the automation of our volumetric modulated arc therapy (VMAT) total body irradiation (TBI) treatment planning. It also aims to determine if plan standardization is impacted by automation. METHODS We introduced automated beam placement for TBI in March 2021. For manual beam placement pre-2021, Python-modified DICOM files were imported to pre-set cumulative meterset weights, with other parameters selected by dosimetrists. Our automated planning script automates these processes and sets gantry stop angles and isocentre placement. To determine the impact of automation on plan standardization, we performed a retrospective review of a matched cohort of 168 patients. Plan parameters were compared with an external standard, and passing rates compared between patient cohorts. The dosimetric impact was investigated by comparing a Body-5 mm homogeneity index (HI = D2%/D98%) and mean lung dose (MLD) between cohorts. RESULTS Results are listed for manual and automated groups respectively. Median (range) passing rates were 97.7% (96.1-100) and 99.2% (98.3-100). Automated plans had a significantly higher passing rate (p ≪ 0.05) and smaller variance (p = 0.001). Most failures were attributed to human error. Automated plans also had more consistent parameter identifiers. After considering dimensional outliers, median (range) Body-5 mm HI were 1.18 (1.14-1.23) and 1.18 (1.15-1.26), and mean ± standard deviation MLD were 103.8 ± 1.3% and 104.1 ± 0.9%. Variances were not significantly different between Body-5 mm HI (p = 0.092) but were for MLD (p = 0.013). CONCLUSIONS Implementation of automated planning in TBI resulted in significantly improved plan standardization. The decrease in variance of the MLD for the automated planning group points towards a potential dosimetric benefit of automation.
Collapse
Affiliation(s)
- Rebecca Frederick
- Department of Medical Physics, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2N 4N2, Canada; Department of Physics and Astronomy, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada.
| | - Lukas Van Dyke
- Department of Medical Physics, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2N 4N2, Canada
| | - Alana Hudson
- Department of Medical Physics, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2N 4N2, Canada; Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Greg Pierce
- Department of Physics and Astronomy, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada; Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada; Varian Medical Systems, Inc., 3100 Hansen Way, Palo Alto, CA 94304, United States
| |
Collapse
|
17
|
Misson-Yates S, Cunningham R, Gonzalez R, Diez P, Clark CH. Optimised conformal total body irradiation: a heterogeneous practice, so where next? Br J Radiol 2023; 96:20220650. [PMID: 36475820 PMCID: PMC10078861 DOI: 10.1259/bjr.20220650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The use of volumetric arc therapy and inverse planning has been in routine use in radiotherapy for two decades. However, use in total body irradiation (TBI) has been more recent and few guidelines exist as to how to plan or verify. This has led to heterogeneous approaches. The goal of this review is to provide an overview of current advanced planning and dosimetry verification protocols used in optimised conformal TBI as a basis for investigating the need for greater standardisation in TBI.
Collapse
Affiliation(s)
- Sarah Misson-Yates
- Department of Medical Physics, Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rissa Cunningham
- Department of Medical Physics, Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Regina Gonzalez
- Department of Medical Physics, Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Patricia Diez
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - Catharine H Clark
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
- Metrology for Medical Physics Centre, National Physical Laboratory, Teddington, UK
- Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
- Medical Physics and Bioengineering Department, University College London, London, UK
| |
Collapse
|
18
|
Pandu B, Khanna D, Mohandass P, Elavarasan R, Ninan H, Vivek TR, Jacob S. A Phantom Study on Feasibility of Manual Field-in-Field Clinical Implementation for Total Body Irradiation and Comparison of Midplane Dose with Different Bilateral TBI Techniques. J Med Phys 2023; 48:59-67. [PMID: 37342604 PMCID: PMC10277292 DOI: 10.4103/jmp.jmp_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The aim of this study is to implement a new treatment technique in total body irradiation (TBI) using the manual field-in-field-TBI (MFIF-TBI) technique and dosimetrically verifying its results with respect to compensator-based TBI (CB-TBI) and open field TBI technique. Materials and Methods A rice flour phantom (RFP) was placed on TBI couch with knee bent position at 385 cm source to surface distance. Midplane depth (MPD) was calculated for skull, umbilicus, and calf regions by measuring separations. Three subfields were opened manually for different regions using the multi-leaf collimator and jaws. The treatment Monitor unit (MU) was calculated based on each subfield size. In the CB-TBI technique, Perspex was used as a compensator. Treatment MU was calculated using MPD of umbilicus region and the required compensator thickness was calculated. For open field TBI, treatment MU was calculated using MPD of umbilicus region, and the treatment was executed without placing compensator. The diodes were placed on the surface of RFP to measure the delivered dose and the results were compared. Results The MFIF-TBI results showed that the deviation was within ± 3.0% for the different regions, except for the neck for which the deviation was 8.72%. In the CB-TBI delivery, the dose deviation was ± 3.0% for different regions in the RFP. The open field TBI results showed that the dose deviation was not within the limit ± 10.0%. Conclusion The MFIF-TBI technique can be implemented for TBI treatment as no TPS is required, and laborious process of making a compensator can be avoided while ensuring that the dose uniformity in all the regions within the tolerance limit.
Collapse
Affiliation(s)
- Bharath Pandu
- Department of Applied Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
- Department of Radiotherapy, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - D. Khanna
- Department of Applied Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
| | - P. Mohandass
- Department of Radiation Oncology, Fortis Hospital, Sahibzada Ajit Singh Nagar, Punjab, India
| | - Rajadurai Elavarasan
- Department of Radiotherapy, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Hima Ninan
- Department of Radiotherapy, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - T. R. Vivek
- Department of Radiation Oncology, Tawam Hospital, Abu Dhabi, UAE
| | - Saro Jacob
- Department of Radiotherapy, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
19
|
Sminia P, Guipaud O, Viktorsson K, Ahire V, Baatout S, Boterberg T, Cizkova J, Dostál M, Fernandez-Palomo C, Filipova A, François A, Geiger M, Hunter A, Jassim H, Edin NFJ, Jordan K, Koniarová I, Selvaraj VK, Meade AD, Milliat F, Montoro A, Politis C, Savu D, Sémont A, Tichy A, Válek V, Vogin G. Clinical Radiobiology for Radiation Oncology. RADIOBIOLOGY TEXTBOOK 2023:237-309. [DOI: 10.1007/978-3-031-18810-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
AbstractThis chapter is focused on radiobiological aspects at the molecular, cellular, and tissue level which are relevant for the clinical use of ionizing radiation (IR) in cancer therapy. For radiation oncology, it is critical to find a balance, i.e., the therapeutic window, between the probability of tumor control and the probability of side effects caused by radiation injury to the healthy tissues and organs. An overview is given about modern precision radiotherapy (RT) techniques, which allow optimal sparing of healthy tissues. Biological factors determining the width of the therapeutic window are explained. The role of the six typical radiobiological phenomena determining the response of both malignant and normal tissues in the clinic, the 6R’s, which are Reoxygenation, Redistribution, Repopulation, Repair, Radiosensitivity, and Reactivation of the immune system, is discussed. Information is provided on tumor characteristics, for example, tumor type, growth kinetics, hypoxia, aberrant molecular signaling pathways, cancer stem cells and their impact on the response to RT. The role of the tumor microenvironment and microbiota is described and the effects of radiation on the immune system including the abscopal effect phenomenon are outlined. A summary is given on tumor diagnosis, response prediction via biomarkers, genetics, and radiomics, and ways to selectively enhance the RT response in tumors. Furthermore, we describe acute and late normal tissue reactions following exposure to radiation: cellular aspects, tissue kinetics, latency periods, permanent or transient injury, and histopathology. Details are also given on the differential effect on tumor and late responding healthy tissues following fractionated and low dose rate irradiation as well as the effect of whole-body exposure.
Collapse
|
20
|
Köksal M, Baumert J, Schoroth F, Scafa D, Koch D, Leitzen C, Sarria GR, Giordano FA, Chatzikonstantinou G, Schmeel LC. Lung sparing and ribcage coverage in total body irradiation delivered by helical tomotherapy. Eur J Med Res 2022; 27:287. [PMID: 36496388 PMCID: PMC9737733 DOI: 10.1186/s40001-022-00918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Helical tomotherapy (HT) is a viable method for delivering total body irradiation (TBI) when preparing patients for allogenic stem cell or bone-marrow transplantation. TBI can be planned to reduce the amount of radiation delivered to organs at risk, such as the lungs, with the aim of decreasing toxicity. However, it is important for the ribcage to receive the prescribed radiation dose in preparation for bone-marrow transplantation. In this retrospective study, we analyzed radiation dose coverage of the lungs and ribcage in patients who underwent TBI delivered by HT to achieve lung dose sparing. METHODS Thirty-five patients were included in the analysis and divided into three groups based on their prescribed radiation dose (4, 8, or 12 Gy). HT was performed using a rotating gantry to reduce radiation to the lungs. Dosimetric parameters for the lungs and ribcage as well as dose-volume histograms were calculated. RESULTS The mean lung D95 was 60.97%, 54.77%, and 37.44% of the prescribed dose for patients receiving 4 Gy, 8 Gy, and 12 Gy, respectively. Ribcage coverage was most optimal for patients receiving 4 Gy, with a D95 of 91.27% and mean homogeneity index of 1.17, whereas patients receiving 12 Gy had a mean D95 of 78.65% and homogeneity index of 1.37, which is still within the range recommended by treatment guidelines. CONCLUSIONS Using HT to achieve lung tissue sparing is a viable approach to minimizing pulmonic complications in patients undergoing TBI. As this planning adjustment does not compromise the dose and quality of coverage received by the ribcage, it is a feasible tool within conditioning regimens for allogeneic bone-marrow transplantation.
Collapse
Affiliation(s)
- Mümtaz Köksal
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Jonathan Baumert
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Felix Schoroth
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Davide Scafa
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Christina Leitzen
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Gustavo R. Sarria
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Frank A. Giordano
- grid.411778.c0000 0001 2162 1728Department of Radiation Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Georgios Chatzikonstantinou
- grid.411088.40000 0004 0578 8220Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Leonard C. Schmeel
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
21
|
Köksal M, Baumert J, Schoroth F, Müdder T, Scafa D, Koch D, Leitzen C, Sarria GR, Schmeel LC, Giordano FA. Helical versus static approaches to delivering tomotherapy to the junctional target for patients taller than 135 cm undergoing total body irradiation. Eur J Med Res 2022; 27:265. [PMID: 36434707 PMCID: PMC9694876 DOI: 10.1186/s40001-022-00886-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/05/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Helical TomoTherapy® is widely used for total body irradiation as a component of conditioning regimens before allogeneic bone-marrow transplantation. However, this technique limits the maximum length of a planning target volume to 135 cm. Therefore, patients taller than 135 cm require two planning computed tomography scans and treatment plans. The junctional target between these two treatment plans is thus a critical region for treatment planning and delivery. Here, we compare radiation coverage of the junctional target between helical and static approaches to treatment planning and delivery to determine which approach allows high quality irradiation planning and provides more robustness against patient movement. METHODS We retrospectively analyzed 10 patients who underwent total body irradiation using a static four-field box planning approach and nine patients who underwent total body irradiation using a helical planning approach. All patients were taller than 135 cm. The junctional target volume was divided into 10 slices of 1 cm thickness (JT1-JT10) for analysis. Dosimetric parameters and dose-volume histograms were compared to assess the quality of coverage of the junctional target between the helical and static planning approaches. RESULTS The D50 for the total junctional target was slightly higher than the prescribed dose for both helical and static approaches, with a mean of 108.12% for the helical group and 107.81% for the static group. The mean D95 was 98.44% ± 4.19% for the helical group and 96.20% ± 4.59% for the static group. The mean homogeneity index covering the entire junctional target volume was 1.20 ± 0.04 for the helical group and 1.21 ± 0.05 for the static group. The mean homogeneity index ranged from 1.08 ± 0.01 in JT1 to 1.22 ± 0.06 in JT6 for the helical group and from 1.06 ± 0.02 in JT1 to 1.19 ± 0.05 in JT6 for the static group. There were no significant differences in parameters between helical and static groups. However, the static approach provided robustness against up to 30 mm of lateral movement of the patient. CONCLUSIONS As long as TBI using helical TomoTherapy® is limited to a maximum length of 135 cm, the junctional target must be addressed during treatment planning. Our analysis shows that the static four-field box approach is viable and offers higher robustness against lateral movement of the patient than the helical approach.
Collapse
Affiliation(s)
- Mümtaz Köksal
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany
| | - Jonathan Baumert
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany
| | - Felix Schoroth
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany
| | - Thomas Müdder
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany
| | - Gustavo R. Sarria
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany
| | - Leonard C. Schmeel
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany
| | - Frank A. Giordano
- Department of Radiation Oncology, University Medical Center Bonn, Bonn, Germany ,grid.411778.c0000 0001 2162 1728Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| |
Collapse
|
22
|
Dejonckheere CS, Böhner AMC, Schmitz E, Holderried TAW, Schmeel LC, Brossart P, Giordano FA, Köksal MA. Peripheral blood kinetics following total body irradiation and allogeneic hematopoietic stem cell transplantation: Timing matters. Cancer Med 2022; 12:7170-7174. [PMID: 36404470 PMCID: PMC10067066 DOI: 10.1002/cam4.5452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/05/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
Total body irradiation (TBI) remains an important component in many conditioning regimens before allogeneic hematopoietic stem cell transplantation (allo-HSCT). Because of its frequent toxicity, patient selection is crucial, making it of interest to identify factors improving engraftment. In this retrospective single center analysis, the characteristics of 48 adult such patients were studied. Mean overall survival (OS) was 22.2 months after allo-HSCT. Interestingly, people with an interval ≥3 days between TBI completion and allo-HSCT showed improved OS, when compared to a shorter interval (p = 0.10). Peripheral blood kinetics after successful engraftment also differed, with a longer interval resulting in a higher platelet count and lower leukocyte and neutrophil (p < 0.05) count. These data suggest that the exact timing of TBI before allo-HSCT might directly impact a patient's survival and could help single out those at higher risk of graft failure who might benefit from an altered conditioning regimen.
Collapse
Affiliation(s)
| | - Alexander M. C. Böhner
- Institute of Molecular Medicine and Experimental Immunology University Hospital Bonn Bonn Germany
| | - Eva Schmitz
- Department of Neurology University Hospital Bonn Bonn Germany
| | - Tobias A. W. Holderried
- Department of Oncology, Hematology, Immuno‐Oncology and Rheumatology University Hospital Bonn Bonn Germany
| | | | - Peter Brossart
- Department of Oncology, Hematology, Immuno‐Oncology and Rheumatology University Hospital Bonn Bonn Germany
| | - Frank A. Giordano
- Department of Radiation Oncology University Medical Center Mannheim Mannheim Germany
| | - Mümtaz A. Köksal
- Department of Radiation Oncology University Hospital Bonn Bonn Germany
| |
Collapse
|
23
|
Lim JE, Sargur Madabushi S, Vishwasrao P, Song JY, Abdelhamid AMH, Ghimire H, Vanishree VL, Lamba JK, Dandapani S, Salhotra A, Lemecha M, Pierini A, Zhao D, Storme G, Holtan S, Aristei C, Schaue D, Al Malki M, Hui SK. Total marrow irradiation reduces organ damage and enhances tissue repair with the potential to increase the targeted dose of bone marrow in both young and old mice. Front Oncol 2022; 12:1045016. [PMID: 36439420 PMCID: PMC9686437 DOI: 10.3389/fonc.2022.1045016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Abstract
Total body irradiation (TBI) is a commonly used conditioning regimen for hematopoietic stem cell transplant (HCT), but dose heterogeneity and long-term organ toxicity pose significant challenges. Total marrow irradiation (TMI), an evolving radiation conditioning regimen for HCT can overcome the limitations of TBI by delivering the prescribed dose targeted to the bone marrow (BM) while sparing organs at risk. Recently, our group demonstrated that TMI up to 20 Gy in relapsed/refractory AML patients was feasible and efficacious, significantly improving 2-year overall survival compared to the standard treatment. Whether such dose escalation is feasible in elderly patients, and how the organ toxicity profile changes when switching to TMI in patients of all ages are critical questions that need to be addressed. We used our recently developed 3D image-guided preclinical TMI model and evaluated the radiation damage and its repair in key dose-limiting organs in young (~8 weeks) and old (~90 weeks) mice undergoing congenic bone marrow transplant (BMT). Engraftment was similar in both TMI and TBI-treated young and old mice. Dose escalation using TMI (12 to 16 Gy in two fractions) was well tolerated in mice of both age groups (90% survival ~12 Weeks post-BMT). In contrast, TBI at the higher dose of 16 Gy was particularly lethal in younger mice (0% survival ~2 weeks post-BMT) while old mice showed much more tolerance (75% survival ~13 weeks post-BMT) suggesting higher radio-resistance in aged organs. Histopathology confirmed worse acute and chronic organ damage in mice treated with TBI than TMI. As the damage was alleviated, the repair processes were augmented in the TMI-treated mice over TBI as measured by average villus height and a reduced ratio of relative mRNA levels of amphiregulin/epidermal growth factor (areg/egf). These findings suggest that organ sparing using TMI does not limit donor engraftment but significantly reduces normal tissue damage and preserves repair capacity with the potential for dose escalation in elderly patients.
Collapse
Affiliation(s)
- Ji Eun Lim
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States
| | | | - Paresh Vishwasrao
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States
| | - Joo Y. Song
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Amr M. H. Abdelhamid
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia University and General Hospital, Perugia, Italy
- Department of Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hemendra Ghimire
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States
| | - V. L. Vanishree
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States
| | - Jatinder K. Lamba
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gianesville, FL, United States
| | - Savita Dandapani
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Mengistu Lemecha
- Department of Molecular and Cellular Biology, Beckman Research Institute, Duarte, CA, United States
| | - Antonio Pierini
- Division of Hematology and Bone Marrow Transplantation, Perugia General Hospital, Perugia, Italy
| | - Daohong Zhao
- Department of Biochemistry and Structural Biology, Univeristy of Texas (UT) Health San Antonio, San Antonio, TX, United States
| | - Guy Storme
- Department of Radiotherapy Universitair Ziekenhuis (UZ) Brussels, Brussels, Belgium
| | - Shernan Holtan
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia University and General Hospital, Perugia, Italy
| | - Dorthe Schaue
- Department of Radiation Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Monzr Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
| | - Susanta K. Hui
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States
| |
Collapse
|
24
|
Oertel M, Eich HT. Strahlentherapeutische Behandlung von Leukämien. BEST PRACTICE ONKOLOGIE 2022. [PMCID: PMC9472722 DOI: 10.1007/s11654-022-00431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hintergrund Ziel der Arbeit Material und Methoden Ergebnisse Schlussfolgerung
Collapse
Affiliation(s)
- Michael Oertel
- Klinik für Strahlentherapie – Radioonkologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Deutschland
| | - Hans Theodor Eich
- Klinik für Strahlentherapie – Radioonkologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Deutschland
| |
Collapse
|
25
|
Total body irradiation using volumetric modulated arc therapy, experience of a cancer hospital in Pakistan. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction:
To report the planning parameters, efficacy and toxicity of total body irradiation using volumetric modulated arc therapy (VMAT).
Methods:
From July 2019 till May 2021, nine patients treated with VMAT-based total body irradiation as a part of the myeloablative regimen for homologous stem cell transplant were evaluated. The CT acquisition, planning parameters, doses to target volume and critical structures were evaluated retrospectively.
Results:
Median age was 24 with median height 172 cm. Average Mean Lung dose was 9·5 Gy, mean dose to kidney was kidney dose 8·4 Gy, planning target volume (PTV) 95% was 98 % and mean heterogeneity index of PTV was 1·2 all patients. Total fraction delivery time including setup was 3·1 h while beam on time was 23 min. Main toxicity observed was mucositis and fatigue, while no Grade 3 or more acute radiation toxicity was observed.
Conclusion:
At our institution, high dose TBI performed with multi-isocentric VMAT is now a standard procedure. Though it is cumbersome and time-consuming process but VMAT offers an advantage of increased dose homogeneity in the target volume with reduction in doses to critical organs especially lungs and kidneys in comparison to standard source to skin distance technique, longer follow-up time is necessary to evaluate our method and long-term toxicity.
Collapse
|
26
|
Abstract
Hintergrund Lymphoide Zellen weisen eine hohe Strahlensensitivität auf, sodass die Strahlentherapie eine sinnvolle Ergänzung der Systemtherapie bei Leukämien darstellt. Vor allem als konditionierende Behandlung vor allogener Stammzelltransplantation ist die Radiotherapie in Form einer Ganzkörperbestrahlung etabliert. Ziel der Arbeit Die vorliegende Arbeit ermöglicht einen Überblick über Durchführung und Nebenwirkungen der strahlentherapeutischen Behandlung bei Leukämien. Hierbei werden insbesondere die (Langzeit‑)Nebenwirkungen nach Ganzkörperbestrahlung dargestellt. Material und Methoden Es erfolgte eine selektive Literaturrecherche über die Datenbank PubMed zur Radiotherapie von Leukämien und zu Ganzkörperbestrahlungen mit Fokus auf Nebenwirkungen sowie technische und konzeptionelle Neuerungen. Ergebnisse Die Ganzkörperbestrahlung ist eine effektive Therapie zur Konditionierung vor allogener Stammzelltransplantation und weist ein diverses, aber beherrschbares, Toxizitätsspektrum mit endokrinen, kardiopulmonalen, okulären, nephrologischen und neurologischen Langzeitnebenwirkungen sowie Sekundärneoplasien auf. Zusätzlich kann eine Radiotherapie in Niedrigdosis effektiv zur Behandlung myeloider Sarkome (Chlorome) angewendet werden. Schlussfolgerung Die Vielfalt der Nebenwirkungen nach Ganzkörperbestrahlung erfordert eine interdisziplinäre und langfristige Nachsorgebetreuung durch internistische Onkolog*innen/Transplantationsmediziner*innen und Radioonkolog*innen. Technische Entwicklungen der Strahlentherapie können in Zukunft eine selektive Adressierung des Knochenmarks sowie der lymphatischen Organe realisieren. Aktuell sind diese noch nicht in der klinischen Routine etabliert und werden im Rahmen klinischer Studien evaluiert.
Collapse
|
27
|
Maerz M, Treutwein M, Nabo J, Dobler B. Three-dimensional printers applied for the production of beam blocks in total body irradiation treatment. J Appl Clin Med Phys 2022; 23:e13592. [PMID: 35290701 PMCID: PMC9121048 DOI: 10.1002/acm2.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/20/2022] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Total body irradiation (TBI) in extended source surface distance (SSD) is a common treatment technique before hematopoietic stem cell transplant. The lungs are organs at risk, which often are treated with a lower dose than the whole body. Methods This can be achieved by the application of blocks. Three‐dimensional (3D) printers are a modern tool to be used in the production process of these blocks. Results We demonstrate the applicability of a specific printer and printing material, describe the process, and evaluate the accuracy of the product. Conclusion The blocks and apertures were found to be applicable in clinical routine.
Collapse
Affiliation(s)
- Manuel Maerz
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Marius Treutwein
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Jan Nabo
- Department for Mathematics and Computer Science, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Barbara Dobler
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| |
Collapse
|
28
|
Tsakanova G, Babayan N, Karalova E, Hakobyan L, Abroyan L, Avetisyan A, Avagyan H, Hakobyan S, Poghosyan A, Baghdasaryan B, Arakelova E, Ayvazyan V, Matevosyan L, Navasardyan A, Davtyan H, Apresyan L, Yeremyan A, Aroutiounian R, Osipov AN, Grigoryan B, Karalyan Z. Low-Energy Laser-Driven Ultrashort Pulsed Electron Beam Irradiation-Induced Immune Response in Rats. Int J Mol Sci 2021; 22:ijms222111525. [PMID: 34768958 PMCID: PMC8584044 DOI: 10.3390/ijms222111525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
The development of new laser-driven electron linear accelerators, providing unique ultrashort pulsed electron beams (UPEBs) with low repetition rates, opens new opportunities for radiotherapy and new fronts for radiobiological research in general. Considering the growing interest in the application of UPEBs in radiation biology and medicine, the aim of this study was to reveal the changes in immune system in response to low-energy laser-driven UPEB whole-body irradiation in rodents. Forty male albino Wistar rats were exposed to laser-driven UPEB irradiation, after which different immunological parameters were studied on the 1st, 3rd, 7th, 14th, and 28th day after irradiation. According to the results, this type of irradiation induces alterations in the rat immune system, particularly by increasing the production of pro- and anti-inflammatory cytokines and elevating the DNA damage rate. Moreover, such an immune response reaches its maximal levels on the third day after laser-driven UPEB whole-body irradiation, showing partial recovery on subsequent days with a total recovery on the 28th day. The results of this study provide valuable insight into the effect of laser-driven UPEB whole-body irradiation on the immune system of the animals and support further animal experiments on the role of this novel type of irradiation.
Collapse
Affiliation(s)
- Gohar Tsakanova
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
- CANDLE Synchrotron Research Institute, Yerevan 0040, Armenia; (A.N.); (H.D.); (A.Y.); (B.G.)
- Correspondence: ; Tel.: +374-941-23070
| | - Nelly Babayan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
- Department of Genetics and Cytology, Faculty of Biology, Yerevan State University, Yerevan 0025, Armenia
| | - Elena Karalova
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
- Experimental Laboratory, Yerevan State Medical University after Mkhitar Heratsi, Yerevan 0025, Armenia
| | - Lina Hakobyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
| | - Liana Abroyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
| | - Aida Avetisyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
- Experimental Laboratory, Yerevan State Medical University after Mkhitar Heratsi, Yerevan 0025, Armenia
| | - Hranush Avagyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
- Experimental Laboratory, Yerevan State Medical University after Mkhitar Heratsi, Yerevan 0025, Armenia
| | - Sona Hakobyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
| | - Arpine Poghosyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
| | - Bagrat Baghdasaryan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
| | - Elina Arakelova
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
- CANDLE Synchrotron Research Institute, Yerevan 0040, Armenia; (A.N.); (H.D.); (A.Y.); (B.G.)
| | - Violetta Ayvazyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
| | - Lusine Matevosyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
- CANDLE Synchrotron Research Institute, Yerevan 0040, Armenia; (A.N.); (H.D.); (A.Y.); (B.G.)
| | - Arpine Navasardyan
- CANDLE Synchrotron Research Institute, Yerevan 0040, Armenia; (A.N.); (H.D.); (A.Y.); (B.G.)
| | - Hakob Davtyan
- CANDLE Synchrotron Research Institute, Yerevan 0040, Armenia; (A.N.); (H.D.); (A.Y.); (B.G.)
| | - Lilit Apresyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
| | - Arsham Yeremyan
- CANDLE Synchrotron Research Institute, Yerevan 0040, Armenia; (A.N.); (H.D.); (A.Y.); (B.G.)
| | - Rouben Aroutiounian
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
- Department of Genetics and Cytology, Faculty of Biology, Yerevan State University, Yerevan 0025, Armenia
| | - Andreyan N. Osipov
- Group for Radiation Biochemistry of Nucleic Acids, N.N. Semenov Federal Research for Chemical Physics, Russian Academy of Sciences, 119991 Moscow, Russia;
- Laboratory for the Development of Innovative Drugs and Agricultural Biotechnology, Moscow Institute of Physics and Technology, 141701 Moscow, Russia
- Experimental Radiobiology and Radiation Medicine Department, State Research Center—Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, 123098 Moscow, Russia
| | - Bagrat Grigoryan
- CANDLE Synchrotron Research Institute, Yerevan 0040, Armenia; (A.N.); (H.D.); (A.Y.); (B.G.)
| | - Zaven Karalyan
- Institute of Molecular Biology NAS RA, Yerevan 0014, Armenia; (N.B.); (E.K.); (L.H.); (L.A.); (A.A.); (H.A.); (S.H.); (A.P.); (B.B.); (E.A.); (V.A.); (L.M.); (L.A.); (R.A.); (Z.K.)
| |
Collapse
|
29
|
Tsakanova G, Arakelova E, Ayvazyan V, Karalyan Z, Matevosyan L, Arakelyan A, Amirkhanyan Z, Davtyan H, Khachatryan V, Grigoryan B. The LD50 for Low-Energy Ultrashort-Pulsed Laser Driven Electron Beam Whole-Body Irradiation of Wistar Rats. Radiat Res 2021; 196:658-667. [PMID: 34478547 DOI: 10.1667/rade-20-00198.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/17/2021] [Indexed: 11/03/2022]
Abstract
Recently, a new technology of low-energy ultrashort-pulsed electron beam (UPEB) accelerators has been developed opening new directions for radiobiology and biomedical research. The purpose of this study was to reveal the lethal dose, LD50 (lethal dose, 50%) delivered by low-energy UPEB whole-body exposure on an organismal level. Wistar rats were exposed to low-energy UPEB whole-body irradiation with different doses and pulse repetition rates to find the LD50 and in silico computer simulations were performed to conduct numerical dose calculations. Survival rate, body weight and water consumption were monitored over the 30-day observation period postirradiation. The LD50 was observed after a 2 Gy dose and pulse repetition rate of 2 Hz. In this group, 50% of the animals survived 30 days postirradiation. The groups of animals exposed to low-energy UPEB radiation at higher doses and pulse repetition rates demonstrated higher mortality rates. We demonstrated that the LD50 dose for the low-energy UPEB whole body irradiation in Wistar rats corresponds to 2 Gy with a pulse repetition rate of 2 Hz. Moreover, we showed that the pulse repetition rate is a very important parameter in the experiments with UPEB and should be assessed in the experiments with such kind of novel irradiation sources.
Collapse
Affiliation(s)
- Gohar Tsakanova
- Institute of Molecular Biology NAS RA, Yerevan, Armenia.,CANDLE Synchrotron Research Institute, Yerevan, Armenia
| | | | | | | | | | | | | | - Hakob Davtyan
- CANDLE Synchrotron Research Institute, Yerevan, Armenia
| | | | | |
Collapse
|
30
|
Zubarovskaya N, Bauer D, Ronceray L, Poetschger U, Kurzmann P, Lender C, Kuzmina Z, Lawitschka A. To Lighten the Burden of Cure: Thyroid Disease in Long-Term Survivors After TBI Conditioning for Paediatric ALL. Front Pediatr 2021; 9:798974. [PMID: 35127596 PMCID: PMC8809136 DOI: 10.3389/fped.2021.798974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/20/2021] [Indexed: 01/29/2023] Open
Abstract
Thyroid disorders are well-studied after allogeneic haematopoietic stem cell transplantation (HSCT) following total body irradiation (TBI)-based conditioning, occurring in 15-30% of paediatric survivors. The toxic effect of TBI is known but data on the role of immunological dysregulation (ID) and chronic graft-versus-host-disease (cGvHD) are scarce. We studied functional and structural thyroid disorders in 97 paediatric ALL patients after TBI-based HSCT, assessing their correlation with patient/transplant characteristics including cGvHD, prolonged immunosuppression and ID. The 10- and 15-year cumulative incidence (CI) of functional disorders was 50 and 60%. Univariate analysis revealed TBI in 6 vs. 8 fractions (p = 0.01), an interval between ALL diagnosis and HSCT <1 year (p = 0.038), and the application of ATG (p = 0.044) as risk factors. The 10- and 15-year CI of structural disorders was 60 and 80%. No correlation between patient/transplant characteristics and structural disorders was observed. cGvHD, prolonged immunosuppression and additional radiotherapy were not associated with any thyroid disease. We observed a significant correlation between ID and the development of thyroid dysfunction in patients with structural changes (10-year CI: 77% for patients with ID vs. 56% without ID, p = 0.02). The impact of our results on thyroid follow-up evaluations and the significance of hormonal replacement therapy are discussed.
Collapse
Affiliation(s)
- Natalia Zubarovskaya
- Stem Cell Transplantation Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Dorothea Bauer
- Stem Cell Transplantation Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Leila Ronceray
- Stem Cell Transplantation Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | | | | | - Carina Lender
- Department of Pediatrics, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Zoya Kuzmina
- Pulmonology Department, Ottakring Hospital, Vienna, Austria
| | - Anita Lawitschka
- Stem Cell Transplantation Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria.,St. Anna Children's Cancer Research Institute, Vienna, Austria
| |
Collapse
|