332MO - Long-term toxicities after allogeneic HSCT with or without total body irradiation: A population-based study in Korea

Background

To compare long-term toxicity incidences, including secondary cancer (Sec.ca) with or without TBI, in Asian patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) using a nationwide database.

Methods

We identified 4,554 patients receiving HSCT for leukemic disease from 2009 to 2016 using the Healthcare Bigdata system of Korea. Incidence rate ratios (IRRs) for Sec.Ca, cataracts, hypothyroidism, chronic kidney disease (CKD), myocardial infarctions (MIs), or strokes were compared, and standardized incidence ratios (SIR) of Sec.ca was also estimated.

Results

TBI was conducted on 1,409 patients (30.9%). No overall survival differences based on TBI were observed. With a median follow-up duration of 58.2 months, 143 patients were diagnosed with subsequent Sec.Ca (3.4%). Incidence rates per 1000 Person-Year (95% CI) were 6.56(4.75–8.84) and 7.23(5.89–8.80) in the TBI and no-TBI groups, respectively (p=.594). Also, the SIR (95% CI) was not significantly increased by TBI [1.32(0.86–1.94) vs. 1.39(1.08–1.77) in the no-TBI group]. In the young age group (0-19 years), SIRs were increased in both groups regardless of TBI (8.60 vs. 11.96). The IRRs (95% CI) of cataracts [1.60(1.30–1.95)], CKD [1.85(1.31–2.62)], and hypothyroidism [1.50(1.07–2.09)] were significantly 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 Sec.ca after allogeneic HSCT, although increased risks of other diseases were noted. Physicians should carefully consider individualized risks and benefits of TBI, with a particular focus by age group.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

Chungnam National Universit.

Disclosure

All authors have declared no conflicts of interest.