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TLI in pediatric patients

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Abstract

Purpose

Hematopoietic progenitor cell transplantation (HSCT) is a procedure used in different hematological diseases as part of the curative treatment, so the investigators propose a system of conditioning of reduced intensity based on total lymphoid irradiation (TLI) as an alternative to the classic total body irradiation (TBI) followed by haploidentical transplantation in patients compatible with a single HLA haplotype, as an alternative to patients who do not have an HLA compatible donor.

Materials and methods

A cohort of 25 patients with hematological disease underwent haploidentical HSCT from February 2015 to May 2018, conditioned with TLI from day − 10 (2–4 days of treatment) followed by thiotepa (5 mg/kg/12 h) and melphalan (70 mg/m2/day) prior to HSCT and prophylaxis with ciclosporin (1.5 mg/kg/12 h). 2 Gy/fraction was administered to complete 8 Gy with IMRT and VMAT technique.

Results

12% rejection of the transplant was obtained with acute GVHD < II (48%) and chronic GVHD 12%. No acute toxicity was recorded in irradiated patients and 56% survival of patients at the end of follow-up.

Conclusion

Conditioning the haploidentical transplant with TLI, IMRT, and VMAT techniques compared with TBI and RT3D-C techniques is a feasible technique that helps inducing the necessary immunosuppression in patients with a high risk of graft rejection, minimal adverse effects, low incidence of GVHD, and high survival rate.

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Authors and Affiliations

  1. Radiation Oncology Department, Hospital Universitario La Paz, Pº de La Castellana, 261, Madrid, 28046, Spain

    A. Ocanto, A. Escribano, L. Glaría, I. Rodríguez & R. Morera

  2. Radiophysics and Radioprotection Department, Hospital Universitario La Paz, Pº de La Castellana, 261, Madrid, 28046, Spain

    C. Ferrer & C. Huertas

  3. Pediatric Hematology-Oncology Department, Hospital Universitario La Paz, Pº de La Castellana, 261, 28046, Madrid, Spain

    A. Pérez

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  1. A. Ocanto
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Correspondence to A. Ocanto.

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Conflict of interest

A. Ocanto: None. A. Escribano: None. L. Glaría: None. I. Rodríguez: None. C. Ferrer: None. C. Huertas: None. A. Pérez: None. R. Morera: None.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments of comparable ethical standard.

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Informed consent was obtained from the parents of all patients undergoing the VAAFT procedure.

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Ocanto, A., Escribano, A., Glaría, L. et al. TLI in pediatric patients. Clin Transl Oncol 22, 884–891 (2020). https://doi.org/10.1007/s12094-019-02205-9

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  • DOI: https://doi.org/10.1007/s12094-019-02205-9

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