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MONDAY, April 1, 2019 (HealthDay News) — For patients with severe hemoglobinopathies undergoing bone marrow transplantation, increasing the dose of total body irradiation is associated with a reduction in graft failure, according to a study published in the April issue of The Lancet Haematology<\/i>.<\/p>\n
Javier Bola\u00f1os-Meade, M.D., from the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, and colleagues enrolled 17 consecutive patients with sickle cell disease and \u03b2-thalassemia major (12 and five, respectively) receiving their first bone marrow transplant. Patients received total body irradiation with 400 cGy administered as a single fraction on day \u22121; unmanipulated bone marrow was collected and infused on day 0. The original planned primary objective was transplant-related mortality and progression-free survival; however, the trial was closed to accrual in 2017 after a coverage decision made by the Centers for Medicare & Medicaid Services. The primary objective was modified to assess engraftment.<\/p>\n
The researchers found that one patient had primary graft failure with recovery of host hemopoiesis; 13 and three patients, respectively, achieved full donor chimerism and had mixed donor-host chimerism. Grade 2 to 4 acute graft-versus-host disease (GVHD) developed in five of 17 patients, and chronic GVHD developed in three patients. In all patients, GVHD had resolved as of the last follow-up; no patients were receiving systemic GVHD therapy.<\/p>\n
“Increasing total body irradiation from 200 cGy to 400 cGy allowed for stable engraftment, which was well tolerated in patients with hemoglobinopathies receiving haploidentical bone marrow transplantation,” the authors write.<\/p>\n
Several authors disclosed financial ties to the pharmaceutical industry.<\/p>\n
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