全身照射TBI用于造血干细胞移植前预处理78例.doc

全身照射用于造血干细胞移植前预处理78例临床分析 李德志，周一兵，万久庆，陈正堂 （第三军医大学新桥医院肿瘤研究所，重庆 400037） 摘 要： 目的 回顾性分析全身照射（total body irradiation,TBI）用于造血干细胞移植治疗白血病和恶性淋巴瘤的作用、照射剂量及并发症。方法 2002年5月至2007年2月本院有78例造血干细胞移植患者使用了全身放疗作为预处理。采用直线加速器8MVX线，吸收剂量率为4.5～5.0 cGy/min，照射剂量为7～11 Gy，连续2d完成。78例中，55例采用传统的先大剂量化疗再放疗的预处理方案，23例采用先TBI再大剂量化疗的顺序。结果 78例使用了TBI为预处理的病例移植全部成功，无严重的放射性肺炎等并发症发生。结论 作者临床设置条件下的全身照射预处理方案是安全、有效的；采用先TBI再大剂量化疗的顺序，可有效减少TBI的即时反应，减少放疗科的准备工作量，又不影响预处理效果，值得临床进一步验证应用；采用直线加速器做TBI对设备有更高的要求，需要我们认真应对。 关键词：全身照射；干细胞移植； 血液肿瘤 中图法分类号： 文献标识码： The clinical analysis of total body irradiation for 78 cases of the hematopoietic blood stem cells transplantation LI De-zhi,ZHOU Yi-bing,WANG Jiu-qing,CHEN Zheng-tang （Institute of PLA Xinqiao Hospital Third Military medical university） Abstract： Objective To analyse the effects,dose and complications of TBI for hematopoietic stem cell transplantation（HSCT）in the treatment of leukemia and malignant lymphoma. Methods From 5 ,2002 to 2, 2007, 78 cases with leukemia, malignat lymphoma received the TBI before transplantation of hematopoietic stem cell. All the patients were irradiated with linear accelerator in 2 days at the total dose of TBI was 7-11Gy,dose rate was 4.5-5.0cGy/min, once per day. 55 in the 78 cases, the traditional high-dose chemotherapy before radiotherapy, TBI first to use in 23 cases. Results All the cases used TBI in transplantation was successful, no serious complications such as pneumonia radioactive. Conclusion The total body irradiation with our method is a safe and effective pretreatment for hematopoietic stem cell transplantation. TBI first to use before the large doses of the chemotherapy to be effective even if the TBI reduction reaction, reducing the workload of the Department of Radiotherapy, without affecting the survival rate. I Key words: total body irradiation; blood stem cell transplantation; malignant tumors in blood 预处理是造血干细胞移植前的重要步骤，大剂量化疗+全身放射治疗是造血干细胞移植的经典预处理方案[1]。本文总结了我院近5年来采用全身照射（total body irradiation,TBI）用于造血干细胞