Ganem G, Saint-Marc Girardin M F, Kuentz M, Cordonnier C, Marinello G, Teboul C, Braconnier F, Vernant J P, Dhumeaux D, Le Bourgeois J P
Service de Radiothérapie, Hôpital Henri Mondor, Creteil, France.
Int J Radiat Oncol Biol Phys. 1988 May;14(5):879-84. doi: 10.1016/0360-3016(88)90009-0.
One hundred and fifty-one consecutive patients underwent allogeneic bone marrow transplantation (B.M.T.) following high-dose chemotherapy and single dose total body irradiation (T.B.I.) for hematologic malignancies between September 1980 and December 1985. All patients included in this study were treated using a 60 Co beam to deliver a prescribed dose of 10 Gy to the mid-plane of the abdomen. Total body irradiation was performed the day before B.M.T. The mean instantaneous dose-rate was 3.5 cGy/min (range: 2.6 to 4.7). The real dose received was measured using thermoluminescent dosimeters (lithium borate). The difference between the doses delivered to the liver and to the mid-plane of the abdomen did not exceed 5%. The mean real dose delivered to the reference point was 10 Gy (range 8.3 to 11.7). Ninety five per cent of the patients received a dose ranging from 9.1 Gy to 10.9 Gy. High-dose cyclophosphamide was given to 126 patients with a "standard-risk" of relapse (60 mg/kg on day 5 and 4 before B.M.T.). Chemotherapy was intensified by the addition of other drugs in 25 patients with "higher-risk" of relapse. We analyzed the effect of the following pretransplant characteristics on the subsequent posttransplant development of V.O.D.: age, sex, ASAT and/or ALAT before conditioning regimen, diagnosis and status of malignant disease, history of liver disease, interval between diagnosis of hematologic malignancy and B.M.T., conditioning regimen (i.e., classical or intensified) and dose delivered to the liver during T.B.I. Seventeen patients were classified as having clinical V.O.D. giving a prevalence of 11.2%. In the first 2 months following B.M.T., death occurred respectively in 9 of 17 (53%) and 23 of 134 (17%) patients with and without clinical V.O.D. Univariate analysis showed that four characteristics were significantly related to an increased prevalence of V.O.D.: sex (11/62 females vs 6/89 males; p less than 0.05); history of liver disease (7/28 vs 10/117 patients without antecedent; p less than 0.01); ASAT and/or ALAT levels greater than 1.5 upper normal limit (11/49 vs 6/102 patients with levels less than 1.5; p less than 0.01) and intensified conditioning regimen (6/25 vs 11/126 patients with classical regimen; p less than 0.05). The conditioning regimen and history of liver disease were highly correlated to transaminases levels. Only two factors, transaminases levels and female sex, remained significantly associated with V.O.D. after multivariate analysis.
1980年9月至1985年12月期间，151例连续性患者因血液系统恶性肿瘤接受了大剂量化疗及单剂量全身照射（TBI）后进行了异基因骨髓移植（BMT）。本研究纳入的所有患者均使用60钴射线束，向腹部中平面给予规定剂量的10 Gy。全身照射在骨髓移植前一天进行。平均瞬时剂量率为3.5 cGy/分钟（范围：2.6至4.7）。使用热释光剂量计（硼酸锂）测量实际接受的剂量。肝脏和腹部中平面所接受剂量的差异不超过5%。参考点的平均实际剂量为10 Gy（范围8.3至11.7）。95%的患者接受的剂量范围为9.1 Gy至10.9 Gy。126例有“标准复发风险”的患者接受了大剂量环磷酰胺治疗（骨髓移植前第5天和第4天给予60 mg/kg）。25例有“较高复发风险”的患者通过添加其他药物强化了化疗。我们分析了以下移植前特征对随后移植后静脉闭塞病（VOD）发生情况的影响：年龄、性别、预处理方案前的谷草转氨酶（ASAT）和/或谷丙转氨酶（ALAT）、恶性疾病的诊断和状态、肝脏疾病史、血液系统恶性肿瘤诊断与骨髓移植之间的间隔时间、预处理方案（即经典方案或强化方案）以及全身照射期间肝脏所接受的剂量。17例患者被归类为患有临床VOD，患病率为11.2%。在骨髓移植后的前2个月，有临床VOD的17例患者中有9例（53%）死亡，无临床VOD的134例患者中有23例（17%）死亡。单因素分析显示，四个特征与VOD患病率增加显著相关：性别（62例女性中有11例，89例男性中有6例；p<0.05）；肝脏疾病史（有既往史的28例患者中有7例，无既往史的117例患者中有10例；p<0.01）；ASAT和/或ALAT水平高于正常上限1.5倍（水平低于1.5倍的49例患者中有11例，水平低于此值的102例患者中有6例；p<0.01）以及强化预处理方案（采用经典方案的126例患者中有11例，采用强化方案的25例患者中有6例；p<0.05）。预处理方案和肝脏疾病史与转氨酶水平高度相关。多因素分析后，只有两个因素，即转氨酶水平和女性性别，仍与VOD显著相关。
