Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy.
Bone Marrow Transplant. 2013 Jul;48(7):908-14. doi: 10.1038/bmt.2013.66. Epub 2013 May 27.
The aim of this study was to determine whether parameters related to TBI impacted upon OS and relapse in patients with acute leukemia in CR who underwent haematopoietic SCT (HSCT) in 11 Italian Radiation Oncology Centres. Data were analysed from 507 patients (313 males; 194 females; median age 15 years; 318 with ALL; 188 with AML; 1 case not recorded). Besides 128 autologous transplants, donors included 192 matched siblings, 74 mismatched family members and 113 unrelated individuals. Autologous and allogeneic transplants were analysed separately. Median follow-up was 40.1 months. TBI schedules and HSCT type were closely related. Uni- and multi-variate analyses showed no parameter was significant for OS or relapse in autologous transplantation. Multivariate analysis showed type of transplant and disease impacted significantly on OS in allogeneic transplantation. Disease, GVHD and TBI dose were risk factors for relapse. This analysis illustrates that Italian Transplant Centre use of TBI is in line with international practice. Most Centres adopted a hyperfractionated schedule that is used worldwide (12 Gy in six fractions over 3 days), which appears to have become standard. TBI doses impacted significantly upon relapse rates.
本研究旨在确定与 TBI 相关的参数是否会影响在 11 个意大利放射肿瘤学中心接受造血干细胞移植（HSCT）的缓解期急性白血病患者的 OS 和复发。对 507 名患者（313 名男性；194 名女性；中位年龄 15 岁；318 例 ALL；188 例 AML；1 例未记录）的数据进行了分析。除了 128 例自体移植外，供体还包括 192 例匹配的兄弟姐妹、74 例不匹配的家庭成员和 113 例无关个体。分别分析了自体和同种异体移植。中位随访时间为 40.1 个月。TBI 方案和 HSCT 类型密切相关。单因素和多因素分析均显示，在自体移植中，无参数对 OS 或复发有显著影响。多因素分析显示，移植类型和疾病对同种异体移植的 OS 有显著影响。疾病、GVHD 和 TBI 剂量是复发的危险因素。这项分析表明，意大利移植中心使用 TBI 与国际惯例一致。大多数中心采用了一种在全球范围内使用的超分割方案（3 天内分 6 次给予 12 Gy），这似乎已成为标准。TBI 剂量对复发率有显著影响。
