For patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), total body irradiation (TBI) has been particularly advocated as a part of the conditioning regimen in case of extramedullary involvement in sanctuary sites such as the central nervous system (CNS), to ensure greater tissue penetration. In resource-limited countries lacking TBI facilities; however, ALL patients undergo radiation-free myeloablative conditioning, though its impacts on post-HSCT outcomes of the patients with pre-HSCT CNS involvement have not been analyzed. In this 14-year series of 278 adult (> 18 y) ALL patients undergoing TBI-free busulfan/cyclophosphamide conditioning allo-HSCT, we found that the long-term probabilities of overall survival, disease free survival, relapse and non-relapse mortality were not significantly different between CNS-involved and CNS-spared patients. Moreover, there was no statistically significant difference in the incidence of post-HSCT CNS relapse between CNS-involved and CNS-spared patients. Pre-HSCT cranial radiation therapy (CRT) showed no significant preventive effect on the likelihood of post-HSCT CNS relapse. Through multivariable regression analysis, grade III-IV acute graft-versus-host disease (GvHD), extensive chronic GvHD and post-HSCT relapse were ascertained as independent determinants of mortality (Adj.R² = 53.9 %, F_(12,265) = 28.1, P < 0.001), while other parameters including Philadelphia translocation, pre-HSCT CNS involvement and CRT were found to have no independent effect. Although this study was not an attempt to compare TBI-based vs. non-TBI conditioning, the TBI-free myeloablative allo-HSCT was shown to be feasible and an option for adult ALL patients with CNS involvement, considering the comparable outcomes between patients with and without CNS involvement.

对于接受异基因造血干细胞移植 (allo-HSCT) 的急性淋巴细胞白血病 (ALL) 患者，特别提倡全身照射 (TBI) 作为预处理方案的一部分，以防髓外受累部位如中央神经系统（CNS），以确保更大的组织渗透。在缺乏 TBI 设施的资源有限的国家；然而，所有患者都接受了无辐射清髓性预处理，尽管尚未分析其对 HSCT 前 CNS 受累患者的 HSCT 后结果的影响。在这个 14 年系列 278 名成人（>18 岁）ALL 患者接受无 TBI 白消安/环磷酰胺预处理 allo-HSCT 中，我们发现总生存期、无病生存期的长期概率，中枢神经系统受累患者和中枢神经系统未受累患者的复发和非复发死亡率没有显着差异。此外，CNS 受累患者和 CNS 未受累患者的 HSCT 后 CNS 复发率无统计学差异。HSCT 前颅内放射治疗 (CRT) 对 HSCT 后 CNS 复发的可能性没有显着的预防作用。通过多变量回归分析，III-IV 级急性移植物抗宿主病 (GvHD)、广泛的慢性 GvHD 和 HSCT 后复发被确定为死亡率的独立决定因素 (Adj.R HSCT 前颅内放射治疗 (CRT) 对 HSCT 后 CNS 复发的可能性没有显着的预防作用。通过多变量回归分析，III-IV 级急性移植物抗宿主病 (GvHD)、广泛的慢性 GvHD 和 HSCT 后复发被确定为死亡率的独立决定因素 (Adj.R HSCT 前颅内放射治疗 (CRT) 对 HSCT 后 CNS 复发的可能性没有显着的预防作用。通过多变量回归分析，III-IV 级急性移植物抗宿主病 (GvHD)、广泛的慢性 GvHD 和 HSCT 后复发被确定为死亡率的独立决定因素 (Adj.R² = 53.9 %, F _(12,265) = 28.1, P < 0.001)，而其他参数包括费城易位、HSCT 前 CNS 受累和 CRT 没有独立影响。尽管本研究并未尝试比较基于 TBI 与非 TBI 预处理，但考虑到患有 CNS 的成年 ALL 患者的可比结果，无 TBI 清髓性 allo-HSCT 被证明是可行的，并且是一种选择。并且没有 CNS 参与。