Heinzelmann Frank, Ottinger Helmut, Müller Carl-Heinz, Allgaier Sandra, Faul Christoph, Bamberg Michael, Belka Claus
Department of Radiation Oncology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
Strahlenther Onkol. 2006 Apr;182(4):222-30. doi: 10.1007/s00066-006-1468-1.
Total-body irradiation (TBI) is a key part of the conditioning regimen before hematopoietic stem cell transplantation (HSCT). The exact role of TBI as part of the conditioning regimen is largely unclear. In order to determine the relevance of TBI, the status of TBI utilization was analyzed on the basis of a nationwide registry.
14,371 patients (1998-2002) documented in the German Stem Cell Transplantation Registry (DRST) were analyzed regarding TBI utilization prior to autologous or allogeneic transplantation, underlying disorder, type of donor, stem cell source, and size of the treatment center.
For autologous HSCT approximately 10% of the patients (873/8,167) received TBI, with chronic lymphocytic leukemia (CLL, approximately 80%, 171/214) and low-grade non-Hodgkin's lymphoma (l-NHL, approximately 35%, 330/929) being the most important disorders. In the allogeneic setting 50% of the patients (2,399/4,904) received TBI, with acute lymphocytic leukemia (ALL, 85%, 794/930), acute myeloid leukemia (AML, 45%, 662/1,487) and chronic myeloid leukemia (CML, 49%, 561/1,156) being the key indications. The type of donor, stem cell source and center size did not strongly influence the use of TBI.
TBI has only a limited role for the conditioning prior to autologous HCST. For allogeneic HSCT TBI is widely accepted with no major changes over the observation time. The use of TBI is generally accepted for ALL, whereas approximately half of the patients with CML or AML received TBI. Although a considerably large database was analyzed, no clear determinants for the use of TBI could be distinguished.
全身照射（TBI）是造血干细胞移植（HSCT）前预处理方案的关键部分。TBI作为预处理方案一部分的确切作用在很大程度上尚不清楚。为了确定TBI的相关性，基于全国性登记系统分析了TBI的使用情况。
对德国干细胞移植登记系统（DRST）中记录的14371例患者（1998 - 2002年）进行分析，内容包括自体或异体移植前的TBI使用情况、基础疾病、供体类型、干细胞来源以及治疗中心规模。
对于自体HSCT，约10%的患者（873/8167）接受了TBI，其中慢性淋巴细胞白血病（CLL，约80%，171/214）和低度非霍奇金淋巴瘤（l - NHL，约35%，330/929）是最重要的疾病类型。在异体移植情况下，50%的患者（2399/4904）接受了TBI，其中急性淋巴细胞白血病（ALL，85%，794/930）、急性髓系白血病（AML，45%，662/1487）和慢性髓系白血病（CML，49%，561/1156）是主要适应证。供体类型、干细胞来源和中心规模对TBI的使用影响不大。
TBI在自体HSCT预处理中的作用有限。对于异体HSCT，TBI被广泛接受，在观察期内无重大变化。ALL患者普遍接受TBI治疗，而约一半的CML或AML患者接受了TBI。尽管分析了相当大的数据库，但仍无法明确区分TBI使用的决定因素。
