Carlos Echecopar , Ismael del Val Rey , Víctor Galán-Gómez , Carlos González-Pérez , Yasmina Mozo del Castillo , Berta González Martínez , Antonio Pérez-Martínez
{"title":"急性淋巴细胞白血病的全身照射范例:面对毒性挑战的治疗效果","authors":"Carlos Echecopar , Ismael del Val Rey , Víctor Galán-Gómez , Carlos González-Pérez , Yasmina Mozo del Castillo , Berta González Martínez , Antonio Pérez-Martínez","doi":"10.1016/j.anpedi.2024.01.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Total body irradiation (TBI) is part of the myeloablative conditioning for hematopoietic stem cell transplantation (HSCT) in malignant hematologic disorders. This therapy has recently shown improved survival in acute lymphoblastic leukemia (ALL) compared to chemotherapy-based regimens. However, side effects are a significant limitation, especially in the pediatric population.</p></div><div><h3>Patients and methods</h3><p>We retrospectively analyzed the survival of patients with ALL who underwent an HSCT at a tertiary hospital between 1996 and 2009 (N<!--> <!-->=<!--> <!-->69 HSCT in 57 patients). We differentiated a cohort that received TBI (N<!--> <!-->=<!--> <!-->44) from another that did not (N<!--> <!-->=<!--> <!-->25). Subsequently, we interviewed the survivors from the TBI group with a minimum of 10 years of follow-up (N<!--> <!-->=<!--> <!-->18), asking about the presence of side effects.</p></div><div><h3>Results</h3><p>The overall survival (OS) at 2 and 5 years was 79.1% and 65.2% respectively for the TBI group and 66.2% and 55.8% for the non-TBI group, although this difference was not significant (<em>P</em>=.31). The event-free survival (EFS) at 2 and 5 years was 77.3% and 63.6% respectively for the TBI group and 56% and 32% for the non-TBI group (<em>P</em>=.02). The probability of relapse (PR) at 2 years for those who received TBI was 10% compared to 28.6% for those who did not receive TBI (<em>P</em>=.005). Survivors who received TBI developed secondary neoplasms (39%), dyslipidemia (67%), cognitive impairments affecting memory (44%), recurrent respiratory infections (39%), thyroid abnormalities (45%), premature ovarian failure (89%), cataracts (22%), and psychological problems (44%). However, the quality of life, as self-assessed by the patients, was considered good for 83% of the participants.</p></div><div><h3>Conclusions</h3><p>Patients who received TBI had significantly higher EFS and lower PR. However, adverse effects are frequent and significant, although they do not subjectively affect quality of life.</p></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1695403324000134/pdfft?md5=857f9cd2511270f702c5db4d618ec6d7&pid=1-s2.0-S1695403324000134-main.pdf","citationCount":"0","resultStr":"{\"title\":\"El paradigma de la irradiación corporal total en la leucemia linfoblástica aguda: efectividad terapéutica frente a los desafíos de toxicidad\",\"authors\":\"Carlos Echecopar , Ismael del Val Rey , Víctor Galán-Gómez , Carlos González-Pérez , Yasmina Mozo del Castillo , Berta González Martínez , Antonio Pérez-Martínez\",\"doi\":\"10.1016/j.anpedi.2024.01.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Total body irradiation (TBI) is part of the myeloablative conditioning for hematopoietic stem cell transplantation (HSCT) in malignant hematologic disorders. This therapy has recently shown improved survival in acute lymphoblastic leukemia (ALL) compared to chemotherapy-based regimens. However, side effects are a significant limitation, especially in the pediatric population.</p></div><div><h3>Patients and methods</h3><p>We retrospectively analyzed the survival of patients with ALL who underwent an HSCT at a tertiary hospital between 1996 and 2009 (N<!--> <!-->=<!--> <!-->69 HSCT in 57 patients). We differentiated a cohort that received TBI (N<!--> <!-->=<!--> <!-->44) from another that did not (N<!--> <!-->=<!--> <!-->25). Subsequently, we interviewed the survivors from the TBI group with a minimum of 10 years of follow-up (N<!--> <!-->=<!--> <!-->18), asking about the presence of side effects.</p></div><div><h3>Results</h3><p>The overall survival (OS) at 2 and 5 years was 79.1% and 65.2% respectively for the TBI group and 66.2% and 55.8% for the non-TBI group, although this difference was not significant (<em>P</em>=.31). The event-free survival (EFS) at 2 and 5 years was 77.3% and 63.6% respectively for the TBI group and 56% and 32% for the non-TBI group (<em>P</em>=.02). The probability of relapse (PR) at 2 years for those who received TBI was 10% compared to 28.6% for those who did not receive TBI (<em>P</em>=.005). Survivors who received TBI developed secondary neoplasms (39%), dyslipidemia (67%), cognitive impairments affecting memory (44%), recurrent respiratory infections (39%), thyroid abnormalities (45%), premature ovarian failure (89%), cataracts (22%), and psychological problems (44%). However, the quality of life, as self-assessed by the patients, was considered good for 83% of the participants.</p></div><div><h3>Conclusions</h3><p>Patients who received TBI had significantly higher EFS and lower PR. 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El paradigma de la irradiación corporal total en la leucemia linfoblástica aguda: efectividad terapéutica frente a los desafíos de toxicidad
Introduction
Total body irradiation (TBI) is part of the myeloablative conditioning for hematopoietic stem cell transplantation (HSCT) in malignant hematologic disorders. This therapy has recently shown improved survival in acute lymphoblastic leukemia (ALL) compared to chemotherapy-based regimens. However, side effects are a significant limitation, especially in the pediatric population.
Patients and methods
We retrospectively analyzed the survival of patients with ALL who underwent an HSCT at a tertiary hospital between 1996 and 2009 (N = 69 HSCT in 57 patients). We differentiated a cohort that received TBI (N = 44) from another that did not (N = 25). Subsequently, we interviewed the survivors from the TBI group with a minimum of 10 years of follow-up (N = 18), asking about the presence of side effects.
Results
The overall survival (OS) at 2 and 5 years was 79.1% and 65.2% respectively for the TBI group and 66.2% and 55.8% for the non-TBI group, although this difference was not significant (P=.31). The event-free survival (EFS) at 2 and 5 years was 77.3% and 63.6% respectively for the TBI group and 56% and 32% for the non-TBI group (P=.02). The probability of relapse (PR) at 2 years for those who received TBI was 10% compared to 28.6% for those who did not receive TBI (P=.005). Survivors who received TBI developed secondary neoplasms (39%), dyslipidemia (67%), cognitive impairments affecting memory (44%), recurrent respiratory infections (39%), thyroid abnormalities (45%), premature ovarian failure (89%), cataracts (22%), and psychological problems (44%). However, the quality of life, as self-assessed by the patients, was considered good for 83% of the participants.
Conclusions
Patients who received TBI had significantly higher EFS and lower PR. However, adverse effects are frequent and significant, although they do not subjectively affect quality of life.
期刊介绍:
La Asociación Española de Pediatría tiene como uno de sus objetivos principales la difusión de información científica rigurosa y actualizada sobre las distintas áreas de la pediatría. Anales de Pediatría es el Órgano de Expresión Científica de la Asociación y constituye el vehículo a través del cual se comunican los asociados. Publica trabajos originales sobre investigación clínica en pediatría procedentes de España y países latinoamericanos, así como artículos de revisión elaborados por los mejores profesionales de cada especialidad, las comunicaciones del congreso anual y los libros de actas de la Asociación, y guías de actuación elaboradas por las diferentes Sociedades/Secciones Especializadas integradas en la Asociación Española de Pediatría.