急性白血病造血干细胞移植前单次全身照射与分次全身照射模式的对比分析  

Comparative analysis of acute leukemia hematopoietic stem cell transplantation in single body irradiation and fractionated total body irradiation mode

作　　者：赵奇[1] 马骁[2] 周菊英[1] 秦颂兵[1] 

机构地区：[1]苏州大学附属第一医院放疗科,江苏苏州215006 [2]苏州大学附属第一医院血液科,江苏苏州215006

出　　处：《中华肿瘤防治杂志》2015年第3期216-220,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的 对比单次全身照射（single total body irradiation,STBI）8 Gy和分次全身照射（fractionated total body irradiation,FTBI） 12 Gy两种不同的全身照射模式,探讨合适的造血干细胞移植前全身照射（total body irradiation,TBI）方案.方法 回顾性分析苏州大学附属第一医院2003-04-05-2010-07-10确诊的160例急性白血病患者资料,所有患者均接受移植前TBI预处理,70例患者进行STBI 8 Gy照射,90例患者行FTBI 12 Gy照射,2次/d,2 Gy/次,连续照射3d,2次间隔6h,比较不同方案的急性期毒副作用、造血重建时间、移植存活率、间质性肺炎（interstitial pneumonia,IP）和急性移植物抗宿主病（acute graft-versus host disease,aGVHD）的发生情况.结果 STBI 8 Gy照射组和FTBI 12 Gy照射组胃肠道反应（恶心、呕吐）发生率分别为61.4％（43/70）和40.0％（36/90）,x2=7.223,P=0.006;口腔黏膜炎分别为71.4％（50/70）和45.6％（41/90）,x2=10.746,P=0.001;腮腺炎分别为64.3％（45/70）和48.9％（44/90）,x2=3.782,P=0.037.两组上述毒副作用相比差异有统计学意义.STBI 8 Gy组中性粒细胞造血重建时间、血小板造血重建时间、移植存活率和Ⅲ～Ⅳ度aGVHD的发生率分别为13.84士3.84、16.69±4.70、95.7％（67/70）和14.3％（10/70）,FTBI12 Gy组分别为14.31±3.79、17.43±5.26、95.6％（86/90）和16.7％（15/90）,两组相比差异无统计学意义.IP发生率FTBI 12 Gy照射组为4.4％（4/90）,STBI 8 Gy照射组为14.3％（10/70）.多因素Logistic回归分析显示,IP的发生与照射方案和剂量率有关,与性别、年龄、干细胞来源和腮腺炎无关.结论 FTBI 12 Gy方案与STBI 8 Gy方案相比可减轻急性期毒副作用,减轻肺部放射损伤,而造血重建时间、移植存活率和aGVHD的发生两种方案相比差异无统计学意义.采用FTBI 12 Gy方案,吸收剂量率控制在4～6 cGy/min,肺中位剂量控制在＜8 Gy,对比STBI 8 Gy方案是安全、有效的造血干细胞移植预处�OBJECTIVE To compare two different total body irradiation （TBI） modes to investigate the appropriate irradiation program before hematopoietic stem cell transplantation.METHODS A retrospective analysis of 160 cases of acute leukemia patient diagnosed between Fifth Apr.2003 and Tenth Jul.2010 was performed.All patients had received TBI pretreatment before transplantation.Seventy patients treated as single TBI （STBI） 8 Gy,90 pataents treated as fractionated TBI （FTBI） 12 Gy irradiation,received irradiation twice daily 2 Gy for three consecutive days,with the interval between the two irradiations being 6 hours.Acute toxicity,hematopoietic reconstitution time,engraftment rate,the incidence of interstitial pneumonia （IP） and acute graft-versus-host disease （aGVHD） of different schemes were compared.RESULTS Gastrointestinal reaction （nausea,vomiting）,gastritis,mumps incidence in single TBI 8 Gy （STBI 8 Gy） irradiation group were 61.4％ （43/70）,71.4％ （50/70）,64.3％ （45/70） respectively.Th incidence of the above-mentioned acute toxicity of FIBI 12 Gy irradiation group were 40％ （36/90）,45.6％ （41/90） and 48.9％ （44/90） respectively.The difference between the two groups was statistically significant by comparison （x2 =7.223,P =0.006 ; x2 =10.746,P=0.001 ;x2 =3.782,P=0.037）.For the STBI 8 Gy group,ANC hematopoietic reconstitution time,PLT hematopoietic reconstitution time,engraftment rate and aGVHD incidence were 13.84±3.84,16.69±4.70,95.7％ （67/70）,and 14.3 ％ （10/70） while those of the FTBI 12 Gy group were 14.31 ±3.79,17.43 ±5.26,95.6％ （86/90） and 16.7％ （15/90）,which showed no significant difference,IP incidence of the FTBI 12 Gy irradiation group was 4.4％ （4/90） while that of the STBI 8 Gy irradiated group was 14.3 ％ （10/70）.Multivariate logistic regression analysis showed that the IP incidence was related to irradiation scheme and dose rate,and has nothing to do with sex,age,source of stem cell and mumps.CONCLUSIONS Com

关 键 词：急性白血病 造血干细胞移植 全身照射 单次全身照射 分次全身照射 间质性肺炎 移植物抗宿主病 

分 类 号：R733.71[医药卫生—肿瘤]