Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
Morsani College of Medicine, University of South Florida, Tampa, Florida.
Transplant Cell Ther. 2021 Jul;27(7):620.e1-620.e9. doi: 10.1016/j.jtct.2021.03.026. Epub 2021 Mar 30.
Allogeneic hematopoietic cell transplantation (allo-HCT) is a curative treatment option for patients with acute lymphoblastic leukemia (ALL). Both total body irradiation (TBI)-based and chemotherapy only-based myeloablative transplantation conditioning regimens have been applied, but the optimal regimen remains unclear. We performed a systematic review to assess the efficacy of TBI-based versus chemotherapy only-based myeloablative conditioning regimens. We searched PubMed, Embase, and Cochrane databases and meeting abstracts for all studies comparing TBI-based and chemotherapy only-based conditioning regimens in patients who underwent allo-HCT for ALL. Two authors independently reviewed all studies for inclusion and extracted data related to overall survival (OS), progression-free survival (PFS), nonrelapse mortality (NRM), relapse, and acute and chronic graft-versus-host disease (GVHD). Eight studies were included in the final analysis. The overall methodological quality of the included studies was optimal. TBI-based regimens showed evidence of benefit compared with chemotherapy only-based conditioning regimens in terms of relapse (relative risk [RR], 0.82; 95% confidence interval [CI], 0.72 to 0.94; 6 studies, 5091 patients), OS (hazard ratio [HR], 0.76; 95% CI, 0.64 to 0.89; 7 studies, 4727 patients), and PFS (HR, 0.74; 95% CI, 0.63 to 0.85; 7 studies, 4727 patients). The TBI-based regimen did not increase the likelihood of grade II-IV acute GVHD (RR, 1.12; 95% CI, 0.92 to 1.36; 5 studies, 4996 patients) or chronic GVHD (RR, 1.10; 95% CI, 1.00 to 1.21; 5 studies, 4490 patients), or NRM (RR, 0.94; 95% CI, 0.69 to 1.28; 6 studies, 4522 patients). However, TBI-based regimens were associated with an increased risk of grade III-IV acute GVHD (RR, 1.29; 95% CI, 1.01 to 1.63; 3 studies, 3675 patients). A subgroup comparison of patients age ≥16 years showed similar results. This systematic review represents evidence supporting the use of TBI-based conditioning regimen in patients undergoing allo-HCT for ALL who are candidates for myeloablative conditioning, as it offers better OS, PFS, and less relapse with acceptable NRM.
异基因造血细胞移植（allo-HCT）是治疗急性淋巴细胞白血病（ALL）患者的一种有治愈可能的治疗选择。全身体照射（TBI）为基础和以化疗为基础的清髓性移植预处理方案都已得到应用，但最佳方案仍不明确。我们进行了一项系统评价，以评估 TBI 为基础与仅以化疗为基础的清髓性预处理方案的疗效。我们检索了 PubMed、Embase 和 Cochrane 数据库以及会议摘要，以获取所有比较 ALL 患者接受 allo-HCT 时 TBI 为基础与仅以化疗为基础的预处理方案的研究。两名作者独立地对所有研究进行了纳入和提取与总生存（OS）、无进展生存（PFS）、非复发死亡率（NRM）、复发以及急性和慢性移植物抗宿主病（GVHD）相关的数据。最终有 8 项研究纳入了分析。纳入研究的整体方法学质量为最佳。与仅以化疗为基础的预处理方案相比，TBI 为基础的方案在复发（相对风险 [RR]，0.82；95%置信区间 [CI]，0.72 至 0.94；6 项研究，5091 例患者）、OS（风险比 [HR]，0.76；95%CI，0.64 至 0.89；7 项研究，4727 例患者）和 PFS（HR，0.74；95%CI，0.63 至 0.85；7 项研究，4727 例患者）方面显示出获益的证据。TBI 为基础的方案并未增加 2 级至 4 级急性 GVHD（RR，1.12；95%CI，0.92 至 1.36；5 项研究，4996 例患者）或慢性 GVHD（RR，1.10；95%CI，1.00 至 1.21；5 项研究，4490 例患者）或 NRM（RR，0.94；95%CI，0.69 至 1.28；6 项研究，4522 例患者）的发生风险。然而，TBI 为基础的方案与 3 级至 4 级急性 GVHD（RR，1.29；95%CI，1.01 至 1.63；3 项研究，3675 例患者）风险增加相关。对年龄≥16 岁患者的亚组比较得出了相似的结果。这项系统评价提供了支持在 ALL 患者接受 allo-HCT 时使用 TBI 为基础的预处理方案的证据，这些患者适合接受清髓性预处理，因为它可提供更好的 OS、PFS 和更少的复发，同时 NRM 可接受。
