Objective: To analyze the efficacy of allo-HSCT with total body irradiation (TBI) and chemotherapy alone in the treatment of adult ALL and to explore the factors affecting prognosis. Methods: The clinical data of 95 adult patients with ALL who underwent allo-HSCT from January 2015 to August 2022 were included. According to the conditioning regimen, the patients were divided into two groups: the TBI plus cyclophosphamide (TBI/Cy) group (n=53) and the busulfan plus cyclophosphamide (Bu/Cy) group (n=42). Hematopoietic reconstitution after transplantation, GVHD, transplantation-related complications, relapse rate (RR), non-relapse mortality (NRM), OS, and LFS were compared, and the factors related to prognosis were analyzed. Results: The median time of neutrophil engraftment was 14 (10-25) days in the TBI/Cy group and 14 (10-24) days in the Bu/Cy group (P=0.106). The median time of megakaryocyte engraftment was 17 (10-42) days in the TBI/Cy group and 19 (11-42) days in the Bu/Cy group (P=0.488). The incidence of grade Ⅱ-Ⅳ acute GVHD (aGVHD) in the TBI/Cy and Bu/Cy groups was 41.5% and 35.7%, respectively (P=0.565). The incidence of grade Ⅲ-Ⅳ aGVHD in these two groups was 24.5% and 4.8%, respectively (P=0.009). The incidence of severe chronic GVHD in the two groups was 16.7% and 13.5%, respectively (P=0.689). The incidence of cytomegalovirus infection, Epstein-Barr virus infection, severe infection, and hemorrhagic cystitis in the two groups was 41.5% and 35.7% (P=0.565), 34.0% and 35.7% (P=0.859), 43.4% and 33.3% (P=0.318), and 20.8% and 50.0% (P=0.003), respectively. The median follow-up time was 37.1 months and 53.3 months in the TBI/Cy and Bu/Cy groups, respectively. The 2-year cumulative RR was 17.0% in the TBI/Cy group and 42.9% in the Bu/Cy group (P=0.017). The 2-year cumulative NRM was 24.5% and 7.1%, respectively (P=0.120). The 2-year LFS was 58.5% and 50.0%, respectively (P=0.466). The 2-year OS rate was 69.8% and 64.3%, respectively (P=0.697). In the multivariate analysis, the conditioning regimen containing TBI was a protective factor for relapse after transplantation (HR=0.304, 95% CI 0.135-0.688, P=0.004), whereas the effect on NRM was not significant (HR=1.393, 95% CI 0.355-5.462, P=0.634). Infection was an independent risk factor for OS after allo-HSCT in adult patients with ALL. Conclusion: allo-HSCT based on TBI conditioning regimen had lower relapse rate and lower incidence of hemorrhagic cystitis for adult ALL, compared with chemotherapy regimen. While the incidence o grade Ⅲ/Ⅳ aGVHD was hgher in TBI conditioning regimen than that in chemotherapy regimen.
目的： 比较含全身放射治疗（TBI）和仅基于化疗预处理方案的异基因造血干细胞移植（allo-HSCT）治疗成人急性淋巴细胞白血病（ALL）的疗效，探讨影响预后的相关因素。 方法： 收集2015年1月至2022年8月于联勤保障部队第九六〇医院血液病科接受allo-HSCT治疗的95例成人ALL患者的临床资料，根据预处理方案不同分为TBI/环磷酰胺组（TBI/Cy组，53例）和白消安/环磷酰胺组（Bu/Cy组，42例）。比较两组在造血重建、移植相关并发症、移植后复发率、非复发死亡率（NRM）、总生存（OS）率、无白血病生存（LFS）率等方面的差异，并对预后影响因素进行分析。 结果： TBI/Cy组、Bu/Cy组中性粒细胞植入中位时间分别为14（10~25）d、14（10~24）d（P=0.106），血小板植入中位时间分别为17（10~42）d、19（11~42）d（P=0.488）；Ⅱ~Ⅳ度急性移植物抗宿主病（aGVHD）累积发生率分别为41.5%、35.7%（P=0.565），Ⅲ/Ⅳ度aGVHD累积发生率分别为24.5%、4.8%（P=0.009），重度慢性移植物抗宿主病（cGVHD）的发生率分别为16.7%、13.5%（P=0.689）；巨细胞病毒（CMV）血症发生率分别为41.5%、35.7%（P=0.565），EB病毒血症发生率分别为34.0%、35.7%（P=0.859），重度感染发生率分别为43.4%、33.3%（P=0.318），出血性膀胱炎发生率分别为20.8%、50.0%（P=0.003）。TBI/Cy组、Bu/Cy组中位随访时间分别为37.1、53.3个月，移植后2年累积复发率分别为17.0%、42.9%（P=0.017），NRM分别为24.5%、7.1%（P=0.120），LFS率分别为58.5%、50.0%（P=0.466），OS率分别为69.8%、64.3%（P=0.697）。多因素分析显示，预处理方案含TBI是allo-HSCT后复发的保护性因素（HR=0.304，95%CI 0.135~0.688，P=0.004），而对NRM的影响不显著（HR=1.393，95%CI 0.355~5.462，P=0.634）；感染是成人ALL患者allo-HSCT后OS的独立危险因素。 结论： 含TBI预处理方案与基于化疗预处理方案allo-HSCT治疗成人ALL比较，Ⅲ/Ⅳ度aGVHD发生率较高，出血性膀胱炎发生率及复发率较低。.
Keywords: Acute lymphocytic leukemia; Conditioning regimen; Stem cell transplantation; Total body irradiation.