Hematologic Cancer

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MO_41_2570 - Peri-Stem Cell Transplant Toxicity after Craniospinal Irradiation: The Influence of Timing

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Peri-Stem Cell Transplant Toxicity after Craniospinal Irradiation: The Influence of Timing
J. R. Gunther1, C. C. Pinnix1, B. Dabaja1, P. Kebriaei2, Y. Nieto3, W. Qiao4, and S. A. Milgrom1; 1The University of Texas MD Anderson Cancer Center, Division of Radiation Oncology, Houston, TX, 2MD Anderson Cancer Center, Department of Stem Cell Transplantation and Cellular Therapy, Houston, TX, 3University of Texas M.D. Anderson Cancer Center, Department of Stem Cell Transplantation and Cellular Therapy, Houston, TX, 4University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX

Purpose/Objective(s): Craniospinal irradiation (CSI) may be used prior to allogeneic stem cell transplantation (SCT) in the management of hematologic malignancies.  We aimed to 1) quantify the incidence of peri-SCT toxicity in patients receiving CSI prior to allogeneic SCT, and 2) determine whether the length of time between CSI and SCT influences the risk of peri-SCT toxicity. Materials/Methods: We identified all adult patients treated with CSI followed by SCT at our institution from 2011-2015.  Patients were excluded if they received TBI-based conditioning with a CSI boost. Outcomes included: 1) peri-SCT mucositis, 2) peri-SCT esophagitis, 3) peri-SCT neurotoxicity, and 4) time to engraftment.  We assessed for an association of these outcomes with time from CSI completion to SCT.  This time was analyzed as a continuous variable and a dichotomous variable with cut-points of 2, 3, and 4 weeks. 

Results: 29 patients were eligible.  The diagnosis was acute lymphoblastic leukemia (n=14, 45%), acute myeloid leukemia (n=8, 26%), chronic myeloid leukemia (n=5, 16%), chronic lymphocytic leukemia (n=1, 3%), and mantle cell lymphoma (n=1, 3%).  The SCT regimen was busulfan-based (n=12, 41%), thiotepa-based (n=7, 24%), or fludarabine-melphalan (n=10, 35%).  The graft was from an HLA-matched sibling (n=3, 10%), matched unrelated donor (n=17, 59%), or haplo-identical donor (n=9, 31%).  Post-SCT methotrexate (MTX) was given to 20 patients (69%).  CSI was to a median dose of 23.4 Gy (range 20-30.6 Gy, IQR 23.4-24 Gy).  14 patients were treated with protons, and 15 with photons.  The median time from CSI to SCT was 27 days (range 7-317 days, IQR 12-44). Peri-SCT toxicity rates are summarized in the Table.  None of these outcomes was associated with time from CSI to SCT.  No association was observed for the complete cohort or subgroups stratified by SCT regimen. We assessed for an association of each outcome with other covariates, including CSI dose, CSI technique (proton vs photon), SCT regimen, and post-SCT MTX receipt. Risk of mucositis was associated with SCT regimen (P=0.04).  Additionally, SCT regimen was associated with time to engraftment (P=0.01), likely due to the more frequent use of thiotepa-based regimens for haploidentical transplants (P=0.01).  No other significant association was identified.

Conclusion: In patients treated with CSI prior to allogeneic SCT, peri-SCT toxicity rates were acceptable.  With the caveat of small numbers, no association was observed between toxicity and time from CSI to SCT.  Because a shorter duration between CSI and SCT did not increase peri-SCT toxicity, it may be advisable to proceed from CSI to SCT quickly to reduce the potential for disease progression prior to SCT.
Toxicity n (%)
Mucositis      Grade 1      Grade 3 1 (3%) 12 (41%)
Esophagitis (unknown for 1 patient)      Grade 1      Grade 2      Grade 3 17 (61%) 2 (7%) 9 (32%)
Neurotoxicity      Grade 1      Grade 2      Grade 3 2 (7%) 5 (17%) 3 (10%)
Time to engraftment      Median (Range) 15 days (8-35 days)

Author Disclosure: J.R. Gunther: None. C.C. Pinnix: None. B. Dabaja: None. Y. Nieto: None. W. Qiao: None.

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