Haploidentical hematopoietic SCT using helical tomotherapy for total-body irradiation and targeted dose boost in patients with high-risk/refractory acute lymphoblastic leukemia
Haploidentical hematopoietic SCT using helical tomotherapy for total-body irradiation and targeted dose boost in patients with high-risk/refractory acute lymphoblastic leukemia
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DOI：
10.1038/s41409-017-0049-5
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发表时间：
2018-04-01
影响因子：
4.8
通讯作者：
Xiao, Haowen
中科院分区：
文献类型：
--
作者：
Jiang, Zujun;Jia, Junsong;Xiao, Haowen
开发了一种使用螺旋断层治疗（HT）的新型预处理方案，以提供10戈伊的全身照射（TBI），同时将剂量增加至12戈伊，用于接受单倍体相合异基因造血干细胞移植（allo-HSCT）的高危或复发/难治性急性淋巴细胞白血病（ALL）患者的全骨髓、中枢神经系统白血病和髓外疾病部位的靶向剂量增加。纳入14例患者，其中8例首次完全缓解（CR 1），1例CR2，1例部分缓解，4例移植时有难治性疾病。中位剂量为11.395戈伊（10.06-12.17 Gy）。中位计划靶体积D95为8.2戈伊（范围7.52-9.01）。骨髓有活性部位的骨骼中位剂量为12.685戈伊（范围11.12-13.52）。这项试验的结果表明，使用HT TBI在接受allo-HSCT的高危ALL患者中，特别是在难治性ALL患者中，可提供令人满意的免疫抑制和良好的恶性细胞根除。中位随访14.6个月（范围4-28）后，4例患者发生非复发性死亡，10例患者在持久CR中存活，包括髓外白血病浸润缓解。移植后1年总生存率和无病生存率均为70.7%。
A novel conditioning regimen using helical tomotherapy (HT) was developed to deliver 10 Gy for total body irradiation (TBI) and simultaneously augment dose to 12 Gy for targeted dose boost to total marrow, central nervous system leukemia, and extramedullary disease sites in patients with high-risk or relapsed/refractory acute lymphoblastic leukemia (ALL) receiving haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT). Fourteen patients were included, eight of these patients were in first complete remission (CR1), one was in CR2, one had a partial response and four patients had refractory disease at transplantation. The median delivered average dose was 11.395 Gy (range 10.06-12.17). The median planning target volume D95 was 8.2 Gy (range 7.52-9.01). The median delivered dose to skeleton bone with active bone marrow sites was 12.685 Gy (range 11.12-13.52). The results of this trial suggest that using HT TBI confers satisfactory immunosuppression and excellent eradication of malignant cells in patients with high-risk ALL undergoing allo-HSCT, especially in those with refractory ALL. After a median follow-up of 14.6 months (range 4-28), four patients experienced non-relapse mortality, ten patients are alive in durable CR including remission of extramedullary leukemic infiltration. One-year overall survival and disease-free survival rates post-transplantation were both 70.7%.