| Part 1. Preliminary result of total marrow irradiation with helical tomotherapy.ObjectiveBone marrow transplantation is one of the most effective methods for treatment of malignant hematological diseases. Radiotherapy combined with chemotherapy is the most commonly used pretreatment before transplantation. To evaluate efficacy and security of total marrow irradiation(TMI) as a preconditioning regimen of Allogeneic peripheral blood stem cell transplantation(Allo-PBSCT) for patients with bone marrow-based malignant disease.MethodsPatients received Helical Tomotherapy(HT) based Total Marrow Irradiation as 4Gy per day for 3 days and followed by cyclophosphamide(Cy) 60 mg/kg for 2 days.ResultsSix patients were treated with TMI. The median age at diagnosis was 18.5 year old. The prescription dose accurately covered all bone regions. The dose reduction of TMI tomotherapy to various OARs compared to TBI varied from 13% to 60%. The γ-analysis passing rates for the head-neck,chest-abdomen,pelvic were 95.8±1.2%、96.2± 1.1%、 99.0 ± 0.5% for HT plans.The average for upper part versus lower part of H-index was 1.18 versus 1.17. The average treatment time for the upper versus lower part in beam-on time was about 39.2 min versus 14.3min. It was recorded that during TMI treatment,five patients suffered from nausea and vomiting varied from grade 1 to grade 2,two patients were painful varied from grade 1 to grade 2,one was of grade 1diarrhea,and one was of grade 2 enteritis were noted. All patients were en-grafted successfully without the grade 3 or grade 4 non-hematological toxicity.ConclusionsThe planning of TMI with HT for the whole body with adequate dose homogeneity,conformity and security was confirmed to be clinically feasible. Acute toxicities were significantly reduced compared to traditional TBI. And TMI may be a new preconditioning regimen for bone marrow transplantation.Part 2. Clinical trial of total marrow irradiation in the Allogeneic peripheral blood stem cell transplantationObjectiveTotal body irradiation(TBI) has played an important role in conditioning regimens for patients under-going hematopoietic stem cell transplantation.Clinical research showed a higher intensified TBI dose could decrease relapsed rate, while increase treatment-related morbidity and mortality. The aim of this study was to evaluate the efficacy and security of total marrow irradiation(TMI) as a preconditioning regimen of Allogeneic peripheral blood stem cell transplantation(Allo-PBSCT) for patients with bone marrow-based malignant disease.Methods10 patients prepared for Allo-PBSCT were treated with preconditioning regimen consisting of TMI(12~15Gy,4~5Gy/f,3f)and cyclophosphamide(Cy),among whom4 cases plus carmustine(BCNU), 1 cases plus Rabbit anti human thymocytes immune globulin(ATG).We use cyclosporin A, methotrexate, mycophenolate mofetil and CD25 monoclonal antibody for Graft-versus-host disease(GVHD) prophylaxis.ResultsAll patients were engrafted successfully. The median time for ANC≧0.5×109/L was13.5(12~18)days and the median time for platelet counts≧20×109/L was 13.5(9~27)days after transplantation. Patients had mild symptoms such as headache, nausea,vomiting, palpitation. There was no interstitial pneumonia, hepatic venous occlusive disease and hemorrhagic cystitis with preconditioning regimen appeared. Two cases developed acute GVHD(1 case of grade II, and 1 case of grade IV). Three cases developed chronic GVHD(2 case of limited-type, and 1 case of extensive-type). The median follow-up time was 7.5(2~20) months. One case died in 100 d after Allo-PBSCT, and the other 9 cases survived with disease-free.ConclusionsAllogeneic peripheral blood stem cell transplantation combined with total marrow irradiation preconditioning regimen is effective for malignant hematological disease. |
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