造血干细胞移植前全身分次照射的临床研究

Study on the clinical effect of fractionated total body irradiation before hematopoietic stem cell transplantation

目的探讨造血干细胞移植前全身照射的剂量与并发症。方法1999年5月至2005年10月对312例造血干细胞移植病人进行了全身放射治疗的预处理。采用^60Coγ射线照射，吸收剂量率为（5．2±1．13）cGy／min，照射总剂量7～12Gy，1次，d，共2d。根据照射总量分为两组：高剂量组（≥10Gy）139例和低剂量组（〈10Gy）173例。比较不同剂量组的毒、副作用、造血重建和植活率等。结果高剂量组除胃肠反应和口腔炎发生率高于低剂量组外，其他早期毒、副作用、造血重建和植活率等均与低剂量组差异无统计学意义。结论采用5cGy／min吸收剂量率，照射总剂量7～12Gy，1次，d，共2d，肺中位剂量控制在7．5Gy，是安全、有效的造血干细胞移植全身照射预处理方案。

Objective To observe the dose level and complications of total body irradiation （TBI） before hematopeietic stem cell transplantation. Methods 312 patients with TBI before heamatopeietic stem cell transplantation were enrolled into the study from May 1999 to October 2005. All patients were irradiated with ^60Co γ-rays in 2 days at the dose rate of （5.2 ± 1.13） cGy/min, once per day. The total dose of TBI was 7-12 Gy.The high dose group （≥10 Gy）had 139 cases, and the low dose group （ 〈 10 Gy）had 173 cases. The toxic reactions, hematopeietic reconstitution and graft survival rate were compared. Results The rate of acute gastrointestinal reactions and oral inflammation in the high dose group was significantly higher than that in the low dose group （P 〈 0.05 ）. The other reactions, hematopoietic reconstitution and graft survival rate was insignificantly different. Conclusions Fractional total body irradiation in 2 days with dose rate of 5 cGy/min, once per day, total dose of 7-12 Gy, the median lung absorbed dose under 7.5 Gy is a safe and effective pretreatment for hematopoietic stem cell transplantation.