Impact of low-dose irradiation and in vivo T-cell depletion on hematopoietic stem cell transplantation for non-malignant diseases using fludarabine-based reduced-intensity conditioning

Reduced-intensity conditioning is widely used with hematopoietic stem cell transplantation for non-malignant diseases: however, the optimal conditioning to ensure stable engraftment has not been established. In this study, we retrospectively compared the impact of low-dose (1–6 Gy) irradiation and i...

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Published in:Bone marrow transplantation (Basingstoke) 2019-08, Vol.54 (8), p.1227-1236
Main Authors: Umeda, Katsutsugu, Yabe, Hiromasa, Kato, Koji, Imai, Kohsuke, Kobayashi, Masao, Takahashi, Yoshiyuki, Yoshida, Nao, Sato, Maho, Sasahara, Yoji, Kato, Keisuke, Adachi, Souichi, Koga, Yuhki, Okada, Keiko, Inoue, Masami, Hashii, Yoshiko, Atsuta, Yoshiko, Morio, Tomohiro
Format: Article
Language:English
Subjects:
631/250/1904
631/532/1542
Bone marrow
Cell Biology
Conditioning
Confidence intervals
Depletion
Diseases
Fludarabine
Globulins
Health risk assessment
Hematology
Hematopoietic stem cells
Internal Medicine
Irradiation
Lymphocytes
Lymphocytes T
Medicine
Medicine & Public Health
Public Health
Radiation
Radiation dosage
Stem cell transplantation
Stem Cells
Subgroups
Thymocytes
Transplantation
Transplants & implants
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Summary:Reduced-intensity conditioning is widely used with hematopoietic stem cell transplantation for non-malignant diseases: however, the optimal conditioning to ensure stable engraftment has not been established. In this study, we retrospectively compared the impact of low-dose (1–6 Gy) irradiation and in vivo T-cell depletion on the clinical outcome of 523 patients with non-malignant disease who underwent a first allogeneic hematopoietic stem cell transplantation using fludarabine-based reduced-intensity conditioning. Use of low-dose irradiation, but not of anti-thymocyte globulin/anti-lymphocyte globulin, showed a beneficial effect on overall survival (adjusted hazard ratio: 0.56; 95% confidence interval: 0.35–0.91, P  = 0.018). Furthermore, use of low-dose irradiation was strongly associated with lower transplant-related mortality (adjusted hazard ratio: 0.55; 95% confidence interval: 0.32–0.96, P  = 0.034). The addition of low-dose irradiation to the conditioning regimen was beneficial, at least to the short-term clinical outcome. A large prospective study with long-term follow-up is now required to extend these findings and establish the optimal hematopoietic stem cell transplant conditioning for patients with at least some subgroups of non-malignant diseases.
ISSN:0268-3369
1476-5365
DOI:10.1038/s41409-018-0418-8