文章：

保持疗效与减轻毒性：造血干细胞移植中传统与新型放射预处理方案

Maintain Efficacy and Spare Toxicity: Traditional and New Radiation-Based Conditioning Regimens in Hematopoietic Stem Cell Transplantation

原文发布日期：21 February 2024

DOI: 10.3390/cancers16050865

类型: Article

开放获取: 是

英文摘要：

Novelty in total body irradiation (TBI) as part of pre-transplant conditioning regimens lacked until recently, despite the developments in the field of allogeneic stem cell transplants. Long-term toxicities have been one of the major concerns associated with TBI in this setting, although the impact of TBI is not so easy to discriminate from that of chemotherapy, especially in the adult population. More recently, lower-intensity TBI and different approaches to irradiation (namely, total marrow irradiation, TMI, and total marrow and lymphoid irradiation, TMLI) were implemented to keep the benefits of irradiation and limit potential harm. TMI/TMLI is an alternative to TBI that delivers more selective irradiation, with healthy tissues being better spared and the control of the radiation dose delivery. In this review, we discussed the potential radiation-associated long-term toxicities and their management, summarized the evidence regarding the current indications of traditional TBI, and focused on the technological advances in radiotherapy that have resulted in the development of TMLI. Finally, considering the most recent published trials, we postulate how the role of radiotherapy in the setting of allografting might change in the future.

摘要翻译： 

尽管异基因干细胞移植领域不断发展，但作为移植前预处理方案组成部分的全身体照射（TBI）技术长期缺乏创新。在此背景下，TBI相关的长期毒性一直是主要关注点之一，尽管其影响与化疗作用难以明确区分，尤其在成年患者群体中更为明显。近年来，为保留放射治疗的益处并限制潜在危害，临床开始采用低强度TBI及差异化照射技术（即全骨髓照射TMI和全骨髓淋巴照射TMLI）。TMI/TMLI作为TBI的替代方案，能实现更具选择性的靶向照射，在精确控制辐射剂量的同时更好地保护健康组织。本综述探讨了放射治疗可能引发的长期毒性及其管理策略，总结了传统TBI当前适应症的相关证据，并重点分析了促成TMLI技术发展的放射治疗技术进步。最后，基于最新临床试验成果，我们对放射治疗在异基因移植领域未来可能发生的角色演变提出展望。

原文链接：

Maintain Efficacy and Spare Toxicity: Traditional and New Radiation-Based Conditioning Regimens in Hematopoietic Stem Cell Transplantation