TOTAL-BODY IRRADIATION IN ACUTE MYELOID-LEUKEMIA AND CHRONIC MYELOGENOUS LEUKEMIA - INFLUENCE OF DOSE AND DOSE-RATE ON LEUKEMIA RELAPSE
TOTAL-BODY IRRADIATION IN ACUTE MYELOID-LEUKEMIA AND CHRONIC MYELOGENOUS LEUKEMIA - INFLUENCE OF DOSE AND DOSE-RATE ON LEUKEMIA RELAPSE
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DOI：
10.1016/0360-3016(89)90105-3
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发表时间：
1989-09-01
影响因子：
7
通讯作者：
ORSATTI, M
中科院分区：
文献类型：
--
作者：
SCARPATI, D;FRASSONI, F;ORSATTI, M
从1981年6月到1987年3月，106名患者——59名急性髓性白血病（AML）和47名慢性粒细胞性白血病（CML）——接受了环磷酰胺60mg/kg的治疗。同种异体骨髓移植前 2 天和全身照射（TBI-990 cGy/3fr/3d 所述剂量）。 79 名患者可评估复发风险：32 名慢性粒细胞白血病（23 名处于第一慢性期，9 名处于加速期），47 名患有急性粒细胞白血病（38 名处于首次完全缓解期，9 名处于后续阶段）。向这些患者提供的实际 TBI 剂量在 839 至 1250 cGy（平均 956 .+-. 101）/3 fr/3d 之间变化，剂量率在 2.7 至 7.25 cGy/min 之间（平均 4.2 .+-. 1.8）。对接受高（> 990 cGy）和低（≤ 990）剂量和/或剂量率（分别> 4 cGy/min 和≤ 4）的患者进行了总体评估，并按白血病类型、阶段和疾病进行了分层。当综合考虑患者时，高总剂量与复发风险降低 (p = 0.0005) 以及高剂量率 (p = 0.03) 显着相关。当考虑特定亚组时，总剂量对复发率的影响对于“早期”和“晚期”白血病都很明显，而剂量率的影响仅出现在第一慢性期的慢性粒细胞白血病中。回顾了相关的放射生物学和临床文献，并证明了剂量分割和剂量率在白血病控制率中的可能作用；在此TBI设置下，必须保证总剂量不小于990cGy/3fr/3d，剂量率不小于4cGy/min。
From June 1981 to March 1987, 106 patients-59 with acute myeloid leukemia (AML) and 47 with chronic myelogenous leukemia (CML)-were treated with Cyclophosphamide 60 mg/kg .times. 2 d and total body irradiation (TBI-990 cGy/3fr/3d described dose) before allogeneic bone marrow transplantation. Seventy-nine patients are evaluable for risk of relapse: 32 with chronic myelogenous leukemia (23 in first chronic phase, 9 in accelerated phase) and 47 with acute myeloid leukemia (38 in first complete remission, 9 in subsequent phases). Actual TBI doses delivered to these patients varied between 839 and 1250 cGy (mean 956 .+-. 101)/3 fr/3d, with dose rates between 2.7 and 7.25 cGy/min (mean 4.2 .+-. 1.8). Patients receiving high (> 990 cGy) and low (.ltoreq. 990) dose and/or dose rate (> 4 cGy/min and .ltoreq. 4, respectively) have been evaluated overall and stratified by type of leukemia and phase and disease. When the patients are considered altogether, high total dose is significantly correlated with decreased risk of relapse (p = 0.0005) as well as high dose rate (p = 0.03). When considering specific subgroups, the influence of total dose on relapse rate is evident both for "early" and "advanced" leukemias, while an impact of dose rate appears only for chronic myelogenous leukemia in 1st chronic phase. Pertinent radiobiological and clinical literature is reviewed, and a possible role of dose fractionation and dose rate in leukemic control rate is evidenced; this TBI setting, total dose not less than 990 cGy/3fr/3d and dose rate not less than 4 cGy/min have to be guaranteed.