Shi Liu, Lu Xuan, Deng Di, Yang Lijing, Zhao Hongli, Shen Jiuling, Wang Xiaoyong, Xie Conghua, Liu An, Cao Yang, Xiong Yu
Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.
Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China.
Clin Transl Radiat Oncol. 2020 Nov 12;26:42-46. doi: 10.1016/j.ctro.2020.11.004. eCollection 2021 Jan.
Total body irradiation (TBI) has been widely utilized as part of the conditioning regimen for hematopoietic stem cell transplantation (HSCT), but is associated with significant toxicities. Targeted TBI using helical Tomotherapy allows precise and homogeneous tumor coverage and excellent sparing of organs at risk. The purpose of this study was to evaluate the clinical outcomes of a novel hypo-fractionation strategy for patients receiving total marrow and involved lymphoid irradiation (TMLI) as part of the conditioning regimen before HSCT.
61 patients (7 acute myelogenous leukemia (AML), 33 acute lymphoblastic leukemia (ALL), 18 non-Hodgkin's lymphoma (NHL), 3 mixed acute leukemia (MAL)) received conditioning radiation treatment with TMLI (8 Gy to bone marrow, 10 Gy to involved field in 2 fractions per day) in conjunction with chemotherapy before transplantation.
The median age of 61 patients with TMLI was 24 (4-54) years. The prescribed dose covered the entire bone and involved target volume, and the dose of organs at risk (OAR) was reduced by 28%-78% of the prescription dose. Grade 1-2 nausea and vomiting occurred in 12 patients and grade 1-2 pain in 6 patients during radiotherapy. Fatigue occurred in 16 patients. 2 patients had diarrhea, enteritis, and 1 patient had fever. None of patient had grade 3-4 non-hematologic adverse reactions. Late (30 days after HSCT) grade 2 toxicities including reversible enteritis occurred in 3 patients. 5 patients developed infectious pneumonia. The 2 years progression-free survival (PFS) was 64.1% (95% CI: 0.16-0.22) and overall survival (OS) was 74.7% (95% CI: 0.19-0.24) for the 61 patients who had received their planned HSCT. The 2-year non-relapse mortality was significantly reduced to 5% in this patient cohort.
This study demonstrates that hypo-fractionated TMLI (8 Gy to bone marrow, 10 Gy to involved field in a single day) as a conditioning regimen for lymphoma and acute leukemia was feasible and the clinical outcomes were acceptable.
全身照射（TBI）已被广泛用作造血干细胞移植（HSCT）预处理方案的一部分，但会带来显著毒性。使用螺旋断层放射治疗进行靶向TBI可实现精确且均匀的肿瘤覆盖，并能出色地保护危及器官。本研究的目的是评估一种新型低分割策略对接受全骨髓及受累淋巴组织照射（TMLI）作为HSCT预处理方案一部分的患者的临床疗效。
61例患者（7例急性髓系白血病（AML）、33例急性淋巴细胞白血病（ALL）、18例非霍奇金淋巴瘤（NHL）、3例混合急性白血病（MAL））在移植前接受了TMLI（骨髓照射8 Gy，受累野照射10 Gy，每天2次分割）联合化疗的预处理放疗。
61例接受TMLI的患者中位年龄为24（4 - 54）岁。处方剂量覆盖了整个骨骼及受累靶区，危及器官（OAR）的剂量降低至处方剂量的28% - 78%。放疗期间，12例患者出现1 - 2级恶心和呕吐，6例患者出现1 - 2级疼痛。16例患者出现疲劳。2例患者出现腹泻、肠炎，1例患者发热。无患者出现3 - 4级非血液学不良反应。晚期（HSCT后30天）2级毒性包括可逆性肠炎，3例患者出现。5例患者发生感染性肺炎。61例接受计划HSCT的患者2年无进展生存率（PFS）为64.1%（95%CI：0.16 - 0.22），总生存率（OS）为74.7%（95%CI：0.19 - 0.24）。该患者队列的2年非复发死亡率显著降至5%。
本研究表明，低分割TMLI（骨髓照射8 Gy，受累野单次照射10 Gy）作为淋巴瘤和急性白血病的预处理方案是可行的，临床疗效可接受。
