TBI与TMLI联合化疗在非血缘脐血移植中应用的对比研究  

Comparative study on the application of TBI and TMLI combined with chemotherapy in unrelated cord blood transplantation

作　　者：王钦瑶 沈建军 刘磊 沈琦 吴韦炜 吴爱东 孙自敏 张红雁 Wang Qinyao;Shen Jianjun;Liu Lei(Dept of Oncological Radiotherapy,The Affiliated Provincial Hospital of Anhui Medical University,Hefei 230001)

机构地区：[1]安徽医科大学附属省立医院肿瘤放疗科,合肥230001 [2]安徽医科大学附属省立医院血液科,合肥230001

出　　处：《安徽医科大学学报》2021年第10期1640-1645,共6页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81470350)。

摘　　要：目的对比研究全身照射(TBI)与全骨髓全淋巴照射(TMLI)联合化疗的预处理方案应用于非血缘脐血移植(UCBT)治疗恶性血液病的安全性及疗效。方法回顾性分析应用UCBT治疗恶性血液病的45例患者资料,根据预处理方案的不同,分为TBI组(31例)和TMLI组(14例)。TBI由电子直线加速器实施,TMLI采用螺旋断层调强放射治疗技术实施。分析比较两组的造血重建情况、危及器官(OAR)受量及急慢性不良反应,并评估TMLI剂量爬坡的安全性及疗效。结果TBI组和TMLI组中性粒细胞植入的中位时间分别为19.50(16~29)d和16.50(12~38)d(P=0.005),42 d内累积植入率为90.32%(95%CI:88.17%~92.47%)和100%(95%CI:97.14%~102.86%)(P=0.025),TMLI组胃肠道反应较小、总体治疗时间较短。结论TMLI为难治性白血病患者、不能耐受大剂量化疗或无法坚持完成TBI的患者提供了新选择,且当TMLI剂量攀升至15 Gy时,不良反应仍可耐受。Objective To compare the efficacy and safety of total body irradiation(TBI)and total bone marrow and lymphoid irradiation(TMLI)combined with chemotherapy for unrelated cord blood transplantation(UCBT)in the treatment of hematological malignancies.Methods Retrospective analysis was performed on 45 patients with hematological malignancies who received UCBT in the affiliated Provincial Hospital of Anhui Medical University.They were divided into TBI group(31 cases)and TMLI group(14 cases)according to different conditioning regimens,in which TBI was performed by electron linear accelerator and TMLI was performed by tomotherapy.The hematopoietic reconstruction,the dose of organs at risk(OAR),the acute and chronic toxic and side effects,and the safety and effectiveness of TMLI dose climbing in the two groups were analyzed and compared.Results The median time of neutrophil engraftment in the TBI group and the TMLI group was 19.50(16-29)days and 16.50(12-38)days respectively(P=0.005),and the cumulative neutrophil engraftment rate by day 42 was 90.32%(95%CI:88.17%-92.47%)and 100%(95%CI:97.14%-102.86%)(P=0.025),respectively.The gastrointestinal reaction in the TMLI group was less and the overall treatment time was shorter.Conclusion TMLI provides a new option for patients with refractory leukemia,who cannot tolerate high-dose chemotherapy or cannot adhere to complete TBI.When TMLI dose climbs to 15 Gy,adverse reactions can be tolerated.

关 键 词：全身照射 全骨髓全淋巴照射 螺旋断层调强放射治疗 白血病 非血缘脐血移植 危及器官 

分 类 号：R733.7[医药卫生—肿瘤]