Tu233 - Comparison of the Occurrences of Long-term Toxicities in Patients Who Received Allogeneic Hematopoietic Stem-cell Transplantation with or Without Total Body Irradiation
Tuesday, June 20, 2023
6:00 PM – 7:45 PM
Jeanny Kwon – associate professor, radiation oncology, Chungnam National University School of Medicine
Objectives: The purpose of this study was to compare long-term toxicity incidences, including secondary malignancies with or without total body irradiation (TBI), in patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) using data from a national population-based database.
Methods: We performed this work using the Healthcare Bigdata system of the Republic of Korea. We identified 4,554 analyzable patients from 2009 to 2016. Incidence rate ratios (IRRs) for secondary cancers (Sec.Ca), cataracts, hypothyroidism, chronic kidney disease (CKD), myocardial infarctions (MIs), or strokes were compared, and propensity-score matching was used. Standardized incidence ratios were also estimated.
Results: TBI was conducted on 1,409 patients (30.9%). In the propensity-score matched cohort, no overall survival differences based on TBI were observed. After the median follow-up time of 58.2 months, 143 patients were diagnosed with Sec.Ca (crude ratio 3.4%). The most commonly observed Sec.Ca were gastrointestinal cancers followed by lymphomas. Incidence rates per 1000 PY were 6.56 and 7.23 in the TBI and no-TBI groups, respectively (p=0.594). The incidence rates of cataracts (IRR, 1.60), CKD (IRR, 1.85), and hypothyroidism (IRR, 1.50) were increased after TBI. However, there were no significant differences in the occurrence of MI and stroke according to TBI.
Conclusions: Our results suggest that modern TBI may not additionally increase the risk of secondary malignancies after allogeneic HSCT, although increased risks of other conditions were noted. Physicians should carefully consider individualized risks and benefits of TBI, with a particular focus on age group. Further studies with long-term follow-up are needed to confirm these findings.
