Marquez Cesar, Hui Caressa, Simiele Eric, Blomain Erik, Oh Justin, Bertaina Alice, Klein Orly, Shyr David, Jiang Alice, Hoppe Richard T, Kovalchuk Nataliya, Hiniker Susan M
Stanford University School of Medicine, Stanford University, Stanford, California, USA.
Department of Radiation Oncology, Stanford University, Stanford, California, USA.
Pediatr Blood Cancer. 2022 Jun;69(6):e29689. doi: 10.1002/pbc.29689. Epub 2022 Apr 4.
Total body irradiation (TBI) is an important component of many conditioning regimens for hematopoietic stem cell transplantation (HSCT), most commonly used in pediatric and adolescent/young adult (AYA) patients. We aimed to evaluate outcomes and toxicities among pediatric and AYA patients treated with TBI utilizing volumetric modulated arc therapy total body irradiation (VMAT-TBI).
We reviewed pediatric and AYA patients treated with VMAT-TBI at our institution from 2019 to 2021. Data on patient and disease characteristics, treatment details, outcomes and toxicities were collected. Overall survival (OS) and relapse-free survival (RFS) were analyzed using the Kaplan-Meier method.
Among 38 patients, 16 (42.1%) were treated with myeloablative regimens and 22 (57.9%) with nonmyeloablative regimens. Median age was 7.2 years (range: 1-27) and median follow-up was 8.7 months (range: 1-21). Lungs D was 7.3 ± 0.3 Gy for myeloablative regimens (range: 6.8-7.8). Kidneys were spared to average mean dose of 71.4 ± 4.8% of prescription dose. Gonadal sparing was achieved for patients treated for nonmalignant diseases to D of 0.7 ± 0.1 Gy. No patient experienced primary graft failure; one (2.6%) experienced secondary graft failure. The most common grade 1-2 acute toxicities were nausea (68.4%) and fatigue (55.3%). Mucositis was the most common grade 3-4 acute toxicity, affecting 39.5% of patients. There were no cases of pneumonitis or nephrotoxicity attributable to TBI.
VMAT-TBI offers increased ability to spare organs at risk in pediatric and AYA patients undergoing HSCT, with a favorable acute/subacute toxicity profile and excellent disease control.
全身照射（TBI）是许多造血干细胞移植（HSCT）预处理方案的重要组成部分，最常用于儿科和青少年/青年（AYA）患者。我们旨在评估接受容积调强弧形放疗全身照射（VMAT-TBI）治疗的儿科和AYA患者的治疗效果及毒性反应。
我们回顾了2019年至2021年在我院接受VMAT-TBI治疗的儿科和AYA患者。收集了患者及疾病特征、治疗细节、治疗效果及毒性反应等数据。采用Kaplan-Meier法分析总生存（OS）和无复发生存（RFS）情况。
38例患者中，16例（42.1%）接受了清髓性方案治疗，22例（57.9%）接受了非清髓性方案治疗。中位年龄为7.2岁（范围：1 - 27岁），中位随访时间为8.7个月（范围：1 - 21个月）。清髓性方案的肺部D值为7.3±0.3 Gy（范围：6.8 - 7.8）。肾脏平均受量为处方剂量的71.4±4.8%。非恶性疾病患者的性腺受量为D 0.7±0.1 Gy，实现了性腺保护。无患者发生原发性移植物失败；1例（2.6%）发生继发性移植物失败。最常见的1 - 2级急性毒性反应为恶心（68.4%）和疲劳（55.3%）。黏膜炎是最常见的3 - 4级急性毒性反应，影响了39.5%的患者。没有因TBI导致的肺炎或肾毒性病例。
VMAT-TBI在接受HSCT的儿科和AYA患者中具有更强的保护危险器官的能力，急性/亚急性毒性反应良好，疾病控制效果优异。
