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Published on: September 18, 2013
A comprehensive comparison between TBI vs non-TBI-based conditioning regimen in pediatric patients with acute
Faezeh Ansari1, Maryam Behfar1, Leila Jafari1
1Pediatric Cell and Gene Therapy Research Centre, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Non-TBI regimens are as effective as TBI for pediatric ALL patients undergoing HSCT regarding overall survival, but TBI leads to higher late toxicity. Non-TBI conditioning is a viable alternative.
Area of Science:
- Hematology
- Pediatric Oncology
- Transplantation Medicine
Background:
- Acute lymphoblastic leukemia (ALL) is a common pediatric cancer.
- Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative option for ALL.
- Conditioning regimens, including total body irradiation (TBI), are crucial for HSCT success.
Approach:
- Systematic literature search across multiple databases (MEDLINE, Scopus, WOS, PMC, Google Scholar).
- Inclusion of grey literature and reference lists.
- Quantitative synthesis using CMA version 2 for meta-analysis.
- Analysis of 8 studies on efficacy/safety and 6 on late toxicity.
Key Points:
- Meta-analysis showed no significant difference in overall survival (OS) between TBI and non-TBI regimens.
- Disease-free survival (DFS) favored TBI-based conditioning (HR 1.503, 95% CI 1.006-2.25).
- Late complications were significantly higher in the TBI group compared to the non-TBI group.
Conclusions:
- Non-TBI conditioning regimens demonstrate comparable efficacy to TBI for OS in pediatric ALL patients undergoing HSCT.
- TBI-based regimens are associated with increased late toxicity.
- Non-TBI regimens represent a potentially safer alternative treatment option.
Introduction:
We aimed to evaluate the efficacy, safety, and latent toxicity of total body irradiation (TBI)-based conditioning regimens compared to non-TBI regimens for pediatric patients (under 18 years old) with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (HSCT).
Methods:
A systematic search was performed on MEDLINE, Scopus, WOS, and PMC. Also, a search for grey literature was performed on Google Scholar and relevant articles' references were included. Relevant articles which met the inclusion criteria were retrieved up to October 31th, 2022. CMA version 2 was used for the quantitative synthesis of the data.
Results:
Eight studies on efficacy and safety of TBI and non-TBI as a conditioning regimen were analyzed and six comparative studies on late toxicity were investigated. The meta-analysis revealed a hazard ratio (HR) of 1.508 (95% CI 0.96-2.35) for overall survival (OS) in instances of non-TBI conditioning. Also, an HR of 1.503 (95% CI 1.006-2.25) for disease-free- survival (DFS) favoring TBI-based conditioning. Late complications were reported to be significantly higher in the TBI conditioning regimen group than in the non-TBI group.
Conclusion:
It appears that non-TBI regimens are as effective as TBI regimens in pediatrics with ALL regarding OS. Occurrence of latent toxicity is higher with TBI conditioning regimen. Conversely, TBI-based regimens are superior to non-TBI conditioning regimens regarding DFS. Considering all aspects, non-TBI conditioning regimens can be an alternative treatment option for pediatric ALL undergoing HSCT.
