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EBMT 2026 | Total nodal irradiation versus low-dose total body irradiation in haploidentical transplantation

Liang Piu Koh, MBBS, MRCP, National University Cancer Institute, Singapore, Singapore, discusses the effect of substituting total nodal irradiation (TNI; 6-7.5 Gy) with single fraction low-dose total body irradiation (2 Gy) in ex vivo TCRαβ-depleted haploidentical transplantation in adults with hematological malignancies. Prof. Koh highlights that the modification reduced non-relapse mortality and improved survival outcomes, without compromising engraftment. This interview took place at the 52nd Annual Meeting of the EBMT in Madrid, Spain.

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Transcript

So this is a protocol that was built on our haplotransplant protocol called the 2017 haplo transplant protocol and there was a major modification of the original protocol. We substituted the total nodal irradiation or TNI from TNI to total body irradiation, which is a two-gray low-dose single fraction irradiation to the body. So the original intention is to decrease the toxicity that is associated with TNI...

So this is a protocol that was built on our haplotransplant protocol called the 2017 haplo transplant protocol and there was a major modification of the original protocol. We substituted the total nodal irradiation or TNI from TNI to total body irradiation, which is a two-gray low-dose single fraction irradiation to the body. So the original intention is to decrease the toxicity that is associated with TNI. So the main finding from this modification is that we have brought down the incidence of acute toxicity to the GI tract, mucositis, and thereby we saw significantly non-relapse mortality, and it all translated into improved outcome in terms of overall survival. So the benefit is that we decrease toxicity, we decrease the death from the complication, and we improve the outcome in the overall survival without any compromise in the blood hematopoietic engraftment.

 

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