Low Dose Cranial Boost in High Risk Adult Acute Lymphoblastic Leukemia Patients Undergoing Bone Marrow Transplant

Publication date: Available online 23 June 2016
Source:Practical Radiation Oncology
Author(s): William Su, Marcher Thompson, Rendi Sheu, Amir Steinberg, Luis Isola, Richard Stock, Richard Bakst
PurposeAcute lymphoblastic leukemia (ALL) has a predilection for CNS involvement. Patients with high risk ALL are often managed with transplant using a radiation-based conditioning regimen. Historically, a high dose prophylactic cranial boost (CB) of ≥12 Gy was given to reduce risk of CNS recurrence. However, the use of CB has fallen out of favor due to toxicity concerns. In high risk adults undergoing transplant at our institution, we have used a low dose 6 Gy CB to reduce toxicity while conditioning adults with fully developed brains. The safety, efficacy, and utility of a low dose CB in adults is poorly studied. Herein, we report their outcomes and toxicity.Methods and MaterialsWe identified all high risk ALL patients undergoing TBI as part of their conditioning regimen. Those that received 6 Gy CB or no CB were included (55 total). Their charts were reviewed and statistical analyses were completed with R (version 2.15.2).ResultsIn patients undergoing CB, 3-year CNS disease free survival and overall survival were 94.7% and 62.7%. In those not undergoing CBs, survivals were 81.8% and 51.5%. Notably, within CB cohort, patients without prior CNS involvement had no CNS failures. In contrast, in non-CB cohort, there were 2 CNS failures in patients with no history of CNS involvement. In CB cohort, the only notable acute toxicity was parotitis (2.8%). Late toxicity in the CB cohort included one instance of cataracts (2.8%) without any evidence of cognitive impairment or potential radiation induced secondary malignancy.Conclusions6 Gy CB is well tolerated in the adult ALL population as part of a radiation-based conditioning regimen. Low dose CB may be considered in adult patients with high risk ALL without prior CNS involvement to reduce the likelihood of recurrence.



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