Outcomes of allogeneic hematopoietic stem cell transplantation with intensity-modulated total body irradiation: A 2-year follow-up prospective study

Intensity-modulated radiation therapy (IMRT) helps achieve good radiation dose conformity and precise dose evaluation. We conducted a single-center prospective study to assess the safety and efficacy of total body irradiation with IMRT (IMRT-TBI) in allogeneic hematopoietic stem cell transplantation. Thirty-nine patients with hematological malignancy who received 12 Gy IMRT-TBI were enrolled with a median follow-up of 934.5 (range, 617–1,254) days. The mean doses for the lungs and kidneys were 7.50 and 9.11 Gy, respectively. The mean maximum dose for the lens (right/left) was 5.75/5.87 Gy. The 2-year overall survival, disease-free survival, cumulative incidence of relapse, and non-relapse mortality were 69%, 64%, 18%, and 18%, respectively. Thirty-six patients developed early adverse events (including four patients with grade 3/4 toxicities). No patient developed primary graft failure, grade III–IV acute graft-versus-host disease, radiation pneumonitis, or cataracts. In conclusion, IMRT-TBI is feasible and efficacious for hematological malignancies with acceptable clinical outcomes.调强放射治疗（Intensity-modulated radiation therapy, IMRT）可实现良好的放射剂量适形性与精准的剂量评估。本研究开展一项单中心前瞻性试验，旨在评估调强放射治疗全身照射（IMRT-TBI）用于异基因造血干细胞移植时的安全性与有效性。本研究共纳入39例接受12 Gy IMRT-TBI治疗的血液系统恶性肿瘤患者，中位随访时间为934.5天（范围：617~1254天）。肺与肾脏的平均受照剂量分别为7.50 Gy与9.11 Gy。双侧晶状体的平均最大受照剂量分别为5.75 Gy（右眼）与5.87 Gy（左眼）。患者的2年总生存率、无病生存率、复发累积发生率与非复发死亡率分别为69%、64%、18%与18%。共有36例患者出现早期不良事件，其中4例患者发生3/4级毒性反应。无患者出现原发性移植失败、Ⅲ~Ⅳ级急性移植物抗宿主病、放射性肺炎或白内障。综上，IMRT-TBI用于血液系统恶性肿瘤治疗具有可行性与有效性，临床结局可接受。