Gocheva Liliya B
Clinic of Radiotherapy, Tsaritsa Joanna University Hospital ISUL, Sofia, Bulgaria.
Folia Med (Plovdiv). 2010 Jan-Mar;52(1):12-7.
The extensive use of bone marrow transplantation (BMT) in the treatment of a number of life threatening hematologic, oncologic and immunodeficiency disorders has come as a result of more than four decades of research and clinical experience. It is estimated that about 50,000 BMT per year are currently performed at more than 500 clinical centers all over the world. Total body irradiation (TBI) in combination with intensive chemotherapy (CT) proves to be a method without alternative in the preparation of patients with hematologic diseases for bone marrow or hematopoietic stem cells transplantation. Fractionated TBI is applied in myeloablative regimens where patients receive between 10 and 15 Gy. In the recent decade establishing the immunoreactivity of the graft lead to the introduction of nonmyeloablative conditioning regimens, including TBI, most often with a single dose of the order of 2 Gy received before transplantation. It is only in the last decade that the Bulgarian onco-radiologic community extended its knowledge and experience in the field of bone marrow transplantology. The first autologous BMT in Bulgaria was carried out in 1997, the first allogeneic BMT with conditioning TBI regimen--in 2002 and the first BMT with nonmyeloablative conditioning regimen including TBI with 2 Gy--in 2005. AIM OF The aim of the present review was to go over some aspects of the clinical experience that has been accumulated for the last ten years in the field of nonmyeloablative conditioning regimens and BMT. We also survey the basis for developing nonmyeloablative conditioning regimens, their aims and purposes, the main indications for their application, observed toxicity and therapeutic efficiency. The clinical experience gained in the last decade shows unambiguously that the BMT with conditioning "mini" TBI regimen, owing to the graft-versus-leukemia or graft-versus-tumor effect, is capable of achieving remission in patients with life threatening, conventional treatment-resistant hematologic, limphoproliferative disorders and some solid tumor.
骨髓移植（BMT）在治疗多种危及生命的血液学、肿瘤学和免疫缺陷疾病中的广泛应用，是四十多年研究和临床经验的成果。据估计，目前全球500多个临床中心每年进行约50000例骨髓移植。全身照射（TBI）联合强化化疗（CT）被证明是为血液病患者进行骨髓或造血干细胞移植准备时的一种无可替代的方法。分次全身照射应用于清髓方案，患者接受10至15 Gy的照射。在最近十年中，由于确立了移植物的免疫反应性，引入了非清髓性预处理方案，包括全身照射，最常见的是在移植前接受单次剂量约2 Gy的照射。仅在过去十年中，保加利亚肿瘤放射学界才在骨髓移植领域扩展了其知识和经验。保加利亚的首例自体骨髓移植于1997年进行，首例采用全身照射预处理方案的异基因骨髓移植于2002年进行，首例采用包括2 Gy全身照射的非清髓性预处理方案的骨髓移植于2005年进行。本综述的目的是回顾过去十年在非清髓性预处理方案和骨髓移植领域积累的一些临床经验。我们还探讨了开发非清髓性预处理方案的依据、其目标和目的、应用的主要适应症、观察到的毒性和治疗效果。过去十年获得的临床经验明确表明，采用“小剂量”全身照射预处理方案的骨髓移植，由于移植物抗白血病或移植物抗肿瘤效应，能够使患有危及生命、对传统治疗耐药的血液学、淋巴增殖性疾病和一些实体瘤的患者实现缓解。
