Breaking barriers: supporting hematopoietic stem cell transplant program through collaborative radiation therapy...

Area of Science:

• Hematology
• Radiation Oncology
• Transplant Medicine

Background:

• Total body irradiation (TBI) offers advantages for hematopoietic stem cell transplant (HSCT) but is limited by availability in resource-constrained settings.
• Hematology centers often lack in-house radiotherapy services, hindering HSCT program development.
• Coordinating with distant radiotherapy facilities presents a potential solution.

Purpose of the Study:

• To evaluate the feasibility of conducting HSCT programs using a reduced-intensity TBI protocol.
• To assess the viability of HSCT in centers without dedicated radiotherapy facilities through external coordination.
• To determine if remote TBI coordination impacts patient outcomes.

Main Methods:

• A study involving 32 patients (median age 20.5 years) with hematological conditions including aplastic anemia and leukemia.
• Conditioning regimens included fludarabine-based combinations; TBI doses were 3 Gy (28 patients) or 2 Gy (4 patients).
• Patients underwent monthly follow-up post-TBI to record major toxicities.

Main Results:

• Median follow-up was 22 months, with 75% of patients alive at study conclusion.
• Acute graft-versus-host disease (GVHD) was the most common acute complication (15.6%).
• Late complications included chronic GVHD (9.3%), Cytomegalovirus (CMV) infection (34.3%), and CMV-induced graft failure (6.2%).

Conclusions:

• Hematopoietic stem cell transplant (HSCT) utilizing total body irradiation (TBI) is feasible via remote radiotherapy coordination.
• This model overcomes the lack of in-house radiotherapy facilities in hematology centers.
• Patient outcomes are not compromised when HSCT is performed with remote TBI support.