造血干细胞移植前全身照射的毒副反应及影响因素分析  

Analysis of relevant factors on side-effects caused by TBI before hematopoietic stem cell transplantation for patients with leukemia

作　　者：陈力[1,2] 任健[1,2] 高峰[1,2] 孙保锦[1,2] 房彤[1,2] 江泯[3] 于顺江[1,2] 

机构地区：[1]北京大学第九临床医学院 [2]北京世纪坛医院肿瘤放疗科,北京100038 [3]中国军事医学科学院附属北京307医院造血干细胞移植科,100071

出　　处：《临床肿瘤学杂志》2010年第1期39-43,共5页Chinese Clinical Oncology

摘　　要：目的观察和分析造血干细胞移植前采用全身照射治疗所产生的近期和晚期毒副反应。方法自1999年5月至2005年12月,我科对312例造血干细胞移植患者进行了全身照射。采用60Coγ射线照射,患者取侧卧体位,腹脐处中心平面剂量率控制在4～6cGy/min,平均(5.2±1.13)cGy/min,总剂量7～12Gy,分1～3次照射,每天照射1次,照射期间制作个体化的肺挡铅进行肺屏蔽。结果在全身照射后,患者近期出现了Ⅰ～Ⅱ级的发热、胃肠道反应、口腔炎及出血性膀胱炎,均可耐受,无需特殊处理。间质性肺炎发生率为9.9%,造血系统重建和干细胞植活率达70%以上,患者均未出现严重的肾功能衰竭。结论采用剂量率5cGy/min照射,总照射剂量控制在7～12Gy,肺中位剂量不超过7.5Gy,1次/天,共照射1～3次的剂量分割模式,是有效和安全的造血干细胞移植预处理方案。Objective To investigate side-effects and relevant influential factors of total body irradiation（TBI） in pretreat- ment of hematopoietic stem cell transplantation patients. Methods From May, 1999 to December, 2005, total 31：2 cases undergoing stem cell transplantation pretreated with TBI using Co-60 γrays were analyzed retrospectively. Total dose delivered was among 7-12Gy, total 1-3 fractions, and 1 time per day were given. The dose rate at body median plane was 4-6cGy/min, mean was （5.2 ± 1.13 ） cGy/ min. Results It was safe and effective with mild and moderate radiation related side-effects（ grade Ⅰ or Ⅱ ） on general status, gastrointestinal tract, oral cavity mucosa, and bladder responses after TBI, and the TBI was well tolerated and interstitial pneumonitis rate was no more than 10%. There were no issues in occurrence of earlier and late complications. Conclusion Total irradiation dose of T- 12Gy in 1-3 fractions with dose rate of around 5cGy/min in which the lung received maximal dose under 7.5Gy is a safe and effective pretreatment method for hematopoietic stem cell transplantations.

关 键 词：全身照射 造血干细胞 移植 预处理 并发症 剂量率 

分 类 号：R730.55[医药卫生—肿瘤]