白血病骨髓移植前大剂量全身照射研究

Total Body Irradiation before Bone Marrow Transplantation for Leukemia

１９８４年１２月至１９９１年４月应用全身照射技术对１６例白血病患者进行异体骨髓移植前的大剂量全身照射，均采用６０钴γ射线，用自行设计和制作的蜡板根据射线均匀度不一制成剂量均整装置，并且采用６次交替仰卧和侧卧的全身照射，使剂量均匀度在人体最高和最低剂量点仅相差８．２％。剂量率１．６５～５．４ｃＧｙ／ｍｉｎ，总剂量随剂量率的增加而递减，从９００ｃＧｙ降至６６０ｃＧｙ。结果：放射反应轻，生长发育影响小，生存质量较高，１、２和３年生存率分别为８１．３％（１３／１６）、７５．０％（９／１２）和６２．５％（５／８）。无一例发生间质性肺炎，仅１例出现骨髓排斥和复发。建议适宜剂量率４～５ｃＧｙ／ｍｉｎ，总剂量７００～８００ｃＧｙ。

Sixteen patients with leukemia were treated by total body irradiation (TBI) followed by bone marrow transplantation (BMT) since Dec.1984 to Apr, 1991.Telecobalt TBI was given to all patients to a total dose of 660～900cGy inversely proportional to the dose rate from 1.65 to 4.54 cGy/min. Because of dose uniformity was made with the wax in individual sites, six fields were radiated alternately,and the difference between the highest and lowest dose points in the body was 8.2%.Radiation side effect was mild. No interstitial pneumonitis occurred.Growth and development had no much influence. Rejection of engrafted donor bonemarrow and disease recurrence occurred in one patient.The 1,2 and 3 year survival rates were 81.3%(13/16),75.0%(9/12) and 62.5%(5/8) respectively. Authors suggest that the appropriate dose rate and total dose would better be 4～5cGy/min and 700 ～ 800 cGy respectively.