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Secondary solid malignancies in long-term survivors after total body irradiation
Isabella Gruber1, Daniel Wolff2, Oliver Koelbl3
1Department of Radiation Oncology, University Hospital Regensburg, Franz-Josef-Strauß Allee 11, Regensburg, Germany. i.gruber@ukr.de.
Radiation Oncology (London, England)
|September 17, 2024
Summary
Higher total body irradiation (TBI) doses in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukemia (AML) correlated with fewer secondary cancers. However, older patients receiving lower TBI doses had higher risks of premature death, complicating risk assessment.
Area of Science:
- Hematology
- Oncology
- Radiation Oncology
Background:
- Allogeneic hematopoietic stem cell transplantation (allo-HSCT) with total body irradiation (TBI) offers curative potential for acute myeloid leukemia (AML).
- Long-term risks include secondary malignancies, with TBI as a potential contributing factor.
Purpose of the Study:
- To investigate the incidence of secondary solid malignancies and precancerous lesions following TBI-based conditioning in AML patients.
- To identify risk factors for these secondary events and analyze competing risks of mortality.
Main Methods:
- Retrospective analysis of 89 AML patients undergoing TBI-based allo-HSCT between 2000 and 2016.
- TBI delivered with a dose rate of 4 cGy/min, twice-daily fractionation.
- Cause-specific hazard models used to assess risk factors and competing risks.
Main Results:
- Median follow-up was 15.2 years; TBI doses ranged from 4 Gy (Reduced-Intensity Conditioning, RIC) to 12 Gy (Myeloablative Conditioning, MAC).
- Cumulative incidences of secondary malignancies/precancerous lesions at 20 years were 17%.
- Higher TBI doses were associated with lower rates of secondary malignancies; older age at TBI correlated with lower malignancy risk but a trend towards premature death.
Conclusions:
- An inverse relationship observed between TBI dose and treatment-related malignancies, though confounded by competing risks.
- Age-related differences in life expectancy may explain the observed inverse relationship, highlighting challenges in risk assessment due to competing risks.
