在首次完全缓解期接受移植的微小残留病阴性但非微小残留病阳性的急性淋巴细胞白血病患者中，8格雷和12格雷全脑照射联合氟达拉滨及移植后环磷酰胺的疗效相当。
Comparable Results Between 8 and 12 Gray TBI in Combination With Fludarabine and Post-Transplant Cyclophosphamide in MRD-Negative but Not in MRD-Positive Acute Lymphoblastic Leukemia Patients Transplanted in First Complete Remission.
作者信息
Steiner Normann, Massoud Radwan, Richter Johanna, Perekhrestenko Tetiana, Gagelmann Nico, Niederwieser Christian, Rathje Kristin, Lastovytska Iryna, Schäfersküpper Mathias, Heidenreich Silke, Rudolph Ina, Zeck Gaby, Janson Dietlinde, Wolschke Christine, Ayuk Francis Ayuketang, Klyuchnikov Evgeny, Kröger Nicolaus
机构信息
Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria.
出版信息
Eur J Haematol. 2025 Jan;114(1):79-88. doi: 10.1111/ejh.14305. Epub 2024 Sep 19.
BACKGROUND
The optimal TBI dose for ALL patients undergoing allogeneic SCT is still not clearly defined.
METHODS
Single-center retrospective analysis of high-risk ALL patients in CR1 treated with 8 Gy (n = 22) or 12 Gy (n = 50) TBI in combination with fludarabine and PTCy. Median patient age in the 8 Gy TBI cohort was 63 (37-79) and 37 (18-56) in the 12 Gy TBI cohort and median follow-up time was 21 months (range 1-92).
RESULTS
OS and LFS at 2 years after 8 Gy were 65% and 55% versus 74% and 74% after 12 Gy (p = 0.3 and p = 0.2, respectively). CIR and NRM at 2 years were 27% and 14% after 8 Gy versus 4% and 20% after 12 Gy (p = 0.004 and p = 0.4, respectively). MRD-positive (+) patients (n = 26) receiving 12 Gy (n = 19) showed better OS (p = 0.01), LFS (p = 0.009), GRFS, lower CIR (p = 0.02), and similar NRM than did MRD+ patients receiving 8 Gy (n = 7). MRD-negative (-) patients (n = 38) receiving 12 Gy (n = 27) had similar OS, LFS, GRFS, lower CIR, and higher NRM (p = 0.04) than did MRD- patients receiving 8 Gy (n = 11).
CONCLUSION
Our study demonstrates that 8 Gy TBI in comparison to 12 Gy TBI results in low NRM but a high relapse rate with similar OS, LFS, and GRFS. In MRD+ high-risk ALL patients, allogeneic SCT with 12 Gy TBI leads to improved OS, LFS, GRFS, and a low relapse rate. Prospective studies comparing the different treatment regimens with larger MRD patient cohorts are needed to confirm this data.
背景
对于所有接受异基因造血干细胞移植的患者，最佳的全身照射（TBI）剂量仍未明确界定。
方法
对处于完全缓解期（CR1）的高危急性淋巴细胞白血病（ALL）患者进行单中心回顾性分析，这些患者接受了8 Gy（n = 22）或12 Gy（n = 50）的TBI联合氟达拉滨和PTCy治疗。8 Gy TBI组患者的中位年龄为63岁（37 - 79岁），12 Gy TBI组为37岁（18 - 56岁），中位随访时间为21个月（范围1 - 92个月）。
结果
8 Gy照射后2年的总生存期（OS）和无白血病生存期（LFS）分别为65%和55%，而12 Gy照射后为74%和74%（p分别为0.3和0.2）。8 Gy照射后2年的累积复发率（CIR）和非复发死亡率（NRM）分别为27%和14%，12 Gy照射后为4%和20%（p分别为0.004和0.4）。接受12 Gy照射的微小残留病（MRD）阳性（+）患者（n = 26，其中n = 19）的OS（p = 0.01）、LFS（p = 0.009）、无移植相关复发生存期（GRFS）更好，CIR更低（p = 0.02），且NRM与接受8 Gy照射的MRD +患者（n = 7）相似。接受12 Gy照射的MRD阴性（-）患者（n = 38，其中n = 27）的OS、LFS、GRFS与接受8 Gy照射的MRD -患者（n = 11）相似，但CIR更低，NRM更高（p = 0.04）。
结论
我们的研究表明，与12 Gy TBI相比，8 Gy TBI导致较低的NRM，但复发率较高，OS、LFS和GRFS相似。在MRD +高危ALL患者中，12 Gy TBI的异基因造血干细胞移植可改善OS、LFS、GRFS，并降低复发率。需要进行前瞻性研究，比较不同治疗方案与更大规模MRD患者队列，以证实这些数据。
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