| Purpose:Unrelated cord blood transplantation(UCBT)has become an important method for the treatment of hematologic diseases.The selection of conditioning regimens before transplantation affects the hematopoiesis and immune system reconstruction after transplantation,the incidence of transplant-related complications,efffcacy and prognosis.This study by comparing the Total body irradiation(TBI)with Total marrow and lymphoid irradiation(TMLI)combined chemotherapy of two different conditioning regimens in the application of UCBT,to analyze the hematopoietic reconstruction,acute or chronic adverse reaction,recurrence,death and the advantages and disadvantages of two conditioning regimens.Evaluate the safety and efficacy of TMLI dose escalation,so as to develop a more scientific conditioning regimen before hematopoietic stem cell transplantation.Methods:Retrospective analysis was performed on 45 patients with hematological malignancies who received UCBT in Anhui Provincial Hospital from January 1,2015 to July 1,2020.They were divided into TBI group(TBI+Ara-c+CY,31 cases)and TMLI group(TMLI+FLU+CY,14 cases).TBI was performed 7-6 days before transplantation by electron linear accelerator,3Gy/Bid,12Gy;Ara-C 2g/m2 Q12 h,5-4 days before transplantation;Cy 60mg/kg,3-2 days before transplantation.TMLI was performed 6-4days before transplantation with tomotherapy equipment(TOMO),TMLI 12-15Gy/ 3f;Flu 30mg/m2 for 3 days;Cy 60mg/kg for 2 days.SPSS 26.0 software and R software analysis package(4.0.3)were used for statistical analysis.Measurement data were expressed as mean±standard deviation(?x±s),Chi-square test compared the percentage of data between the two groups,and Mann-Whitney test compared the median of the two groups.The measurement data of non-normal distribution were compared by Kruskal-Wallis rank sum test.Competitive risk model was used to analyze the cumulative neutrophil and platelet engraftment rate,GVHD,non-recurrence mortality and recurrence rate,and Grey test was conducted.P < 0.05 was considered statistically significant.Hematopoietic reconstruction,the dose of organ at risk,acute and chronic adverse reactions such as GVHD,recurrence and death were analyzed and compared between the two groups,and the safety and efficacy of TMLI dose climbing were evaluated.Results:Follow up to August 1.2020,the median time of neutrophil engraftment in the TBI group and the TMLI group was 19.50(16-29)and 16.50(12-38)days respectively(P=0.005),and the cumulative neutrophil engraftment rate by day 42 was 90.32%(95%CI,88.17%-92.47%)and 100%(95%CI,97.14%-102.86%)(P=0.025),respectively.I-III level of fever,headache,nausea,vomiting,mucositis acute radiation related adverse reactions been see in patients after radiotherpy,but not seen IV lethal side effects.The gastrointestinal reaction in the TMLI group was less and the overall treatment time was shorter.Conclusion:The neutrophils were implanted earlier in TMLI group than in TBI.TMLI can increase the irradiation dose,and when the TMLI dose escalates to 15 Gy,the adverse reactions can be tolerated.Minor gastrointestinal side effects;The less time to complete the whole treatment can reduce the error caused by involuntary movement of the patient.The Tomo-based TMLI program provides an option for patients who are unable to tolerate high-dose chemotherapy after multiple chemotherapy treatments,patients with relapsed refractory leukemia,or older patients with generally less benign conditions. |
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