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Ionizing radiation exposure after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 57, pages 827–829 (2022)Cite this article

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Recipients of allogeneic hematopoietic cell transplant (HCT) routinely undergo diagnostic radiographic tests during transplant care. While concerns have been raised over the risk of mutagenic events with exposure to low-dose ionizing radiation, particularly in children [1,2,3,4], this remains controversial. We sought to quantify radiation exposure from medical imaging and evaluate its impact on transplant outcomes in a large cohort of adults who underwent first allogeneic HCT with a CD34+ cell-selected bone marrow or peripheral blood stem cell graft for acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndrome (MDS) at Memorial Sloan Kettering Cancer Center between 2000 and 2013. All patients and donors provided written informed consent for treatment. The MSKCC Institutional Review and Privacy Board approved this retrospective study.

Patients received myeloablative conditioning with total body irradiation- or chemotherapy-based regimens as previously described [5, 6]. For this analysis, we identified patients who remained alive 1 year post-HCT without relapse or second allogeneic HCT for any indication. We tabulated all radiology exams, including fluoroscopic procedures, performed in the first year post-HCT, and then calculated total cumulative 1-year baseline radiation dosing for each patient using published estimates of typical nominal effective doses corresponding to the individual imaging exams [7,8,9,10]. Knowing that at times patients might have undergone testing outside our institution, we performed a chart review in a random sample of 40 patients to determine how frequently this occurred. We determined that 5 of the 40 patients had possible or definite outside radiographic tests between days 0 and 365, based on reports of outside hospitalizations or other health care encounters. Of these five patients, full radiology reports were available for 3. Given the relatively small number of outside examinations and inconsistent ability to confirm what tests were done, we opted to exclude outside tests.

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Fig. 1: Outcomes among recipients of CD34+ cell-selected PBSCT based on imaging-related radiation exposure, below vs. above the median.

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Acknowledgements

This work was supported by the NYU WIRELESS industrial affiliates program and in part by National Institutes of Health award number P01 CA23766 and NIH/NCI Cancer Center Support Grant P30 CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Christina Cho, Molly A. Maloy, Ann A. Jakubowski, Esperanza B. Papadopoulos, Miguel-Angel Perales & Sergio A. Giralt

  2. Weill Cornell Medical College, New York, NY, 10065, USA

    Christina Cho, Omer Aras, Ann A. Jakubowski, Esperanza B. Papadopoulos, Miguel-Angel Perales & Sergio A. Giralt

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sean M. Devlin

  4. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Omer Aras & Lawrence T. Dauer

  5. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Lawrence T. Dauer

  6. Department of Radiology, New York University Langone Medical Center, New York, NY, USA

    Theodore S. Rappaport

Authors
  1. Christina Cho
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Contributions

CC, OA, LTD, AAJ, EBP, MAP, TSR, and SAG designed the study. MAM collected the data. SMD performed the statistical analysis. CC, MAP, and SAG analyzed and interpreted the data. All authors contributed to and approved the final manuscript.

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Correspondence to Christina Cho.

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Competing interests

CC, MAM, SMD, OA, LTD, AAJ, EBP, and TSR: none. MAP: Reports honoraria from Abbvie, Astellas, Celgene, Bristol-Myers Squibb, Incyte, Karyopharm, Kite/Gilead, Merck, Miltenyi Biotec, MorphoSys, Novartis, Nektar Therapeutics, Omeros, and Takeda. He serves on DSMBs for Cidara Therapeutics, Servier and Medigene and the scientific advisory board of NexImmune. He has received research support for clinical trials from Incyte, Kite/Gilead, Miltenyi Biotec, and Novartis. He serves in a volunteer capacity as a member of the Board of Directors of Be The Match (National Marrow Donor Program, NMDP), as well as on the CIBMTR Cellular Immunotherapy Data Resource (CIDR) Executive Committee. SAG: Reports honoraria and consulting fees from Actinium, Amgen, Celgene, Jazz Scientific, Kite, Novartis, Omeros, and Miltenyi; and research funding from Actinium, Amgen, BMS, Celgene, Janssen, Novartis, Miltenyi, Pfizer, Sanofi, and Takeda. He has served on scientific advisory boards for Actinium, BMS, Celgene, GSK, Jazz Scientific, Janssen, Pfizer, and Sanofi.

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Cho, C., Maloy, M.A., Devlin, S.M. et al. Ionizing radiation exposure after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 57, 827–829 (2022). https://doi.org/10.1038/s41409-022-01612-x

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