Total Body Irradiation Versus Chemotherapy Conditioning in Pediatric Acute Lymphoblastic Leukemia Patients Undergoing Hematopoietic Stem Cell Transplant: A Systematic Review and Meta-Analysis

Allogeneic hematopoietic stem cell transplant (HSCT) is indicated in pediatric patients with acute lymphoblastic leukemia (ALL) who have relapsed or are at a very high risk of relapse during first complete remission. Two types of myeloablative conditioning are employed before allogeneic HSCT: total...

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Published in:Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2023-04, Vol.23 (4), p.249-258
Main Authors: Rehman, Mohammad Ebad Ur, Chattaraj, Asmi, Mahboob, Anber, Ijaz, Zarnab, Franco, Diana, Farhan, Muhammad, Dharma, Kuldeep, Mumtaz, Hassan, Saeed, Sajeel, Basit, Jawad, Aslam, Muhammad Muaaz, Iftikhar, Ahmad, Faraz, Fatima, Anwer, Faiz
Format: Article
Language:English
Subjects:
Adolescent
Adult
Busulfan - therapeutic use
Child
Child, Preschool
Graft versus host disease
Graft vs Host Disease - drug therapy
Graft vs Host Disease - etiology
Graft vs Host Disease - prevention & control
Hematopoietic Stem Cell Transplantation - methods
Humans
Infant
Infant, Newborn
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
Recurrence
Retrospective Studies
Transplantation Conditioning - methods
Transplantation, Homologous
Whole body irradiation
Young Adult
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Summary:Allogeneic hematopoietic stem cell transplant (HSCT) is indicated in pediatric patients with acute lymphoblastic leukemia (ALL) who have relapsed or are at a very high risk of relapse during first complete remission. Two types of myeloablative conditioning are employed before allogeneic HSCT: total body irradiation (TBI)-based regimens and chemotherapy (CHT) alone. This study compares the efficacy and safety of TBI-based regimens and CHT-based conditioning in pediatric, adolescent, and young adult patients with ALL (0-24 years old). TBI-based and CHT-conditioning regimens were evaluated in 4262 and 1367 patients, respectively, from 15 studies. Compared to CHT alone, TBI-based regimens were associated with better overall survival (OS), relative risk (RR) 1.21, better event-free survival (RR 1.34), and a reduced risk of relapse (RR 0.69). Both approaches had comparable risk of acute graft-versus-host disease (GVHD), grades 3 to 4 acute GVHD, chronic GVHD, and nonrelapse mortality (NRM). In the subgroup analysis for patients in first complete remission, TBI-based regimens and CHT alone had comparable OS and NRM. Our results demonstrate the superiority of TBI-based regimens compared to CHT alone in pediatric patients with ALL.
ISSN:2152-2650
2152-2669
DOI:10.1016/j.clml.2023.01.004