REGIMEN-RELATED TOXICITY IN PATIENTS UNDERGOING BONE-MARROW TRANSPLANTATION
REGIMEN-RELATED TOXICITY IN PATIENTS UNDERGOING BONE-MARROW TRANSPLANTATION
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DOI：
10.1200/jco.1988.6.10.1562
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发表时间：
1988-10-01
影响因子：
45.3
通讯作者：
THOMAS, ED
中科院分区：
文献类型：
--
作者：
BEARMAN, SI;APPELBAUM, FR;THOMAS, ED
骨髓移植与显著的发病率和死亡率相关，其中一些是由于高剂量的放化疗。为了定量认为是由于准备方案引起的毒性（称为方案相关毒性[RRT]），开发了一个系统，其中毒性分级为0（无）至4（致死性）。回顾性研究了195例接受骨髓移植治疗白血病的患者，以确定临床上认为是由于准备方案引起的毒性是否受到其他因素的影响，如疾病状态、移植物抗宿主病（GVHD）预防和同种异体性。所有患者均在至少一个器官中发生I级毒性，30例发生III-IV级（危及生命或致命）RRT。RRT在复发患者比缓解患者中更常见（P = 0.04），在接受15.75戈伊全身照射（TBI）的患者比接受12.0戈伊TBI的患者（P =-0.028），以及在接受同种异体骨髓的患者比接受自体骨髓的患者（P = 0.0029）。在这项研究中，自体骨髓接受者没有出现III-IV级毒性。控制自体骨髓移植的多变量分析显示，TBI剂量是III-IV级RRT的唯一统计学显著预测因素。发生III级RRT的患者不太可能在移植后存活100天，尽管并非所有死亡都可归因于RRT。在三个或更多器官中发生II级毒性的患者比在两个或更少器官中发生II级毒性的患者更有可能在100天内死亡（P = 0.0027）。该系统通常能够区分RRT与在骨髓受体中观察到的其他毒性。这种分级系统可用于开发新的制备方案。
Bone marrow transplantation is associated with significant morbidity and mortality, some of which is due to high-dose chemoradiotherapy. In order to quantitate toxicity that was felt to be due to the preparative regimen (termed regimen-related toxicity [RRT]), a system was developed in which toxicities were graded from 0 (none) to 4 (fatal). One hundred ninety-five patients who underwent marrow transplantation for leukemia were studied retrospectively to determine whether toxicities that were clinically felt to be due to the preparative regimen were influenced by other factors such as disease status, graft-versus-host-disease (GVHD) prophylaxis, and allogenicity. All patients developed grade I toxicity in at least one organ, and 30 developed grades III-IV (life-threatening or fatal) RRT. RRT was more common in relapsed patients v remission patients (P = .04), in those receiving 15.75 Gy total body irradiation (TBI) v 12.0 Gy TBI (P = -.028), and in those receiving allogeneic marrow v autologous marrow (P = .0029). Autologous marrow recipients did not develop grades III-IV toxicity in this study. A multivariate analysis controlling for autologous marrow grafting showed that the dose of TBI was the only statistically significant predictor of grades III-IV RRT. Those patients who developed grade III RRT were unlikely to survive 100 days from transplant, though not all deaths could be attributed to RRT. Patients who developed grade II toxicity in three or more organs were more likely to die within 100 days than those developing grade II toxicity in two or less organs (P = .0027). This system was generally able to distinguish RRT from other toxicities observed in marrow recipients. Such a grading system may be of use in the development of new preparative regimens.