Ben Abdeljelil Nour, Ladeb Saloua, Dahmani Talel, Kochbati Lotfi, Lakhal Amel, El Fatmi Rym, Torjemane Lamia, Belloumi Dorra, Besbes Mounir, El Benna Farouk, Nasr Ben Ammar Chiraz, Ben Othman Tarek
Centre National de Greffe de Moelle Osseuse, Tunis, Tunisia.
Service de Radiothérapie, Institut Salah Azaiz, Tunis, Tunisia.
Rep Pract Oncol Radiother. 2020 May-Jun;25(3):436-441. doi: 10.1016/j.rpor.2020.03.023. Epub 2020 Apr 28.
The objective of the study was to estimate the cumulative incidence (CI) of relapse, relapse-free survival (RFS) and overall survival (OS) in ALL patients after a once-a-day fractionated TBI (F-TBI) regimen with 9.9 Gy. The secondary objectives were evaluation of short and long-term toxicity and non-relapse mortality (NRM).
Total body irradiation (TBI), as a part of the conditioning regimen before allogeneic stem cell transplantation (ASCT) for acute lymphoblastic leukemia (ALL), allows disease control by eradicating residual blast cells in the transplant recipient.
Retrospective study conducted in patients with ALL who received between March 2003 and December 2013 a conditioning regimen with F-TBI and chemotherapy. Irradiation was delivered with 3.3 Gy once-a-day for three consecutive days.
Eighty-seven patients were included. The median age was 19 years (range: 5-49 years). The 3-year CI of relapse was 30%. The estimated 3-year RFS and OS were 54% and 58%, respectively. Cumulative incidence of acute graft-versus-host disease (aGVHD) grade II-IV and chronic GVHD (cGVHD) was 31% and 40%, respectively. Interstitial pneumonitis was observed in 2 patients. The 3-year CI of NRM was 16%. In multivariate analysis, cGVHD was associated with a lower CI of relapse (RR = 0.26, 95% CI: 0.07-0.95, = 0.04). High-risk cytogenetics was associated with a lower RFS (RR = 2, 95 CI: 1.04-3.84, = 0.03). Grade II-IV aGVHD was an independent predictor of higher CI of NRM (RR = 6.7, 95% CI: 1.4-31.7, = 0.02).
Once-a-day F-TBI regimen is effective, safe and practical in patients who underwent ASCT for ALL.
本研究的目的是评估接受每日一次、分次剂量为9.9 Gy的全身照射（F-TBI）方案的急性淋巴细胞白血病（ALL）患者的复发累积发生率（CI）、无复发生存期（RFS）和总生存期（OS）。次要目的是评估短期和长期毒性以及非复发死亡率（NRM）。
全身照射（TBI）作为急性淋巴细胞白血病（ALL）异基因干细胞移植（ASCT）前预处理方案的一部分，可通过清除移植受者体内残留的原始细胞来控制疾病。
对2003年3月至2013年12月期间接受F-TBI和化疗预处理方案的ALL患者进行回顾性研究。连续三天每天一次给予3.3 Gy照射。
纳入87例患者。中位年龄为19岁（范围：5 - 49岁）。3年复发CI为30%。估计3年RFS和OS分别为54%和58%。急性移植物抗宿主病（aGVHD）II - IV级和慢性移植物抗宿主病（cGVHD）的累积发生率分别为31%和40%。2例患者出现间质性肺炎。3年NRM的CI为16%。多因素分析中，cGVHD与较低的复发CI相关（RR = 0.26，95%CI：0.07 - 0.95，P = 0.04）。高危细胞遗传学与较低的RFS相关（RR = 2，95%CI：1.04 - 3.84，P = 0.03）。II - IV级aGVHD是NRM较高CI的独立预测因素（RR = 6.7，95%CI：1.4 - 31.7，P = 0.02）。
每日一次的F-TBI方案对接受ALL的ASCT患者有效、安全且实用。
