F/C+AIECy预处理方案在自体造血干细胞移植治疗侵袭性B细胞NHL中的疗效观察OACSTPCD
Effect of auto-HSCT using conditioning regimen F/C+AIECy for aggressive B cell NHL
背景 自体造血干细胞移植(autologous hematopoietic stem cell transplantation,Auto-HSCT)在年轻高危险度分层的侵袭性B细胞非霍奇金淋巴瘤(B-cell non-Hodgkin's lymphoma,B-NHL)患者治疗中作为一线巩固方案,逐渐成为国内外专家的共识.现行预处理方案下,依然有超过 30%患者移植后复发,故预处理方案仍有改进空间.目的 探究预处理方案为氟达拉滨或克拉屈滨联合阿糖胞苷+伊达比星+依托泊苷+环磷酰胺(F/C+AIECy)的自体造血干细胞移植一线巩固治疗高危、中高危侵袭性B-NHL的安全性和有效性.方法 回顾性分析 2015年 1月—2020年 1月我院应用本预处理方案的高危、中高危侵袭性B-NHL患者临床资料,分析干细胞采集情况、预处理相关不良反应、植入情况、患者疗效及生存与复发情况.结果 共纳入 32例患者,男 20例,女 12例,中位年龄 42(范围:15～60)岁.采集单个核细胞和CD34+细胞的中位数分别为 11.55(范围:8.05～14.76)×108/kg、4.56(范围:1.58～15.24)×106/kg.所有患者均获得造血重建,植入率为 100%;白细胞植入的中位时间为 10(范围:7～20)d,血小板植入的中位时间为 14(范围:12～30)d.移植期间感染发生率为 68.75%,其他 2级及以上不良反应发生率:黏膜炎 18.75%、呕吐或腹泻 46.88%、肝损害 15.63%、出血 6.25%,无预处理相关脏器衰竭和死亡事件.移植后3个月评估总缓解率由移植前的 56.25%提升至 84.38%(P=0.027).中位随访时间 38.5(范围:10～83)个月,8例复发,4例死亡,3年复发率为21.87%,32例患者1年总生存(overall survival,OS)率和无进展生存(progression-free survival,PFS)率分别为 93.8%、86.9%,3年OS率和PFS率分别为 86.5%、75.6%,5年OS率和PFS率分别为 78.6%、68.0%.结论 F/C+AIECy预处理方案的Auto-HSCT一线巩固治疗年轻高危险度分层侵袭性B细胞NHL安全有效,对提高缓解率、降低移植后复发及改善生存有益.
Background Autologous hematopoietic stem cell transplantation(Auto-HSCT)is still a consolidation treatment choice for young patients with high-risk,high-intermediate-risk aggressive B-cell non-Hodgkin's lymphoma(B-NHL)as frontline therapy.With the current pre-treatment plan,more than 30%of patients still experience recurrence after transplantation,so continuous improvement is still needed for the pre-treatment plan.Objective To investigate the safety and effectiveness of Auto-HSCT using tumor-ablative conditioning regimen F/C+AIECy(Fludarabine/Cladribine+Idarubicin+Cytarabine+Etoposide+Cytoxan)for patients with aggressive B cell non-Hodgkin's lymphoma(B-NHL).Methods Clinical data about 32 patients with high-risk,high-intermediate-risk aggressive B-NHL received above-mentioned therapeutic regimen from January 2015 to January 2020 were analyzed retrospectively,and conditioning-related toxicity,engraftment,survival and relapse rate were evaluated.Results A total of 32 patients were included,including 20 males and 12 females,with a median age of 42(range:15-60)years.The medians of collected mononuclear cells and CD34+cells were 11.55(range:8.05-14.76)×108/kg and 4.56(range:1.58-15.24)×106/kg,respectively.All patients had successfully completed hematopoietic reconstruction with the implantation rate of 100%,and the median of neutrophil and platelet reconstitution time was 10(range:7-20)days and 14(range:12-30)days in these cases.The incidence of infection during transplantation was 68.75%,and during transplantation the incidence rates of adverse reaction in grade 2 or higher were as follows:mucositis accounting for 18.75%,nausea and vomiting for 46.88%,liver injury for 15.63%,bleeding for 6.25%.No conditioning-related organs'failure and mortality events were found.The complete remission(CR)rate of all patients was significantly higher at 3 months after transplantation compared with before transplantation(56.25%vs 84.38%,P=0.027).The median follow-up time was 38.5(range:10-83)months,during which disease progression occurred in 8 cases,death occurred in 4 cases,and the 3-year relapse rate of all patients was 21.87%.The 1-year overall survival(OS)rate and progression-free survival(PFS)rate was 93.8%and 86.9%,the 3-year OS rate and PFS rate was 86.5%and 75.6%,the 5-year OS rate and PFS rate was 78.6%and 68%.Conclusion Auto-HSCT using conditioning regimen F/C+AIECy is safe and effective for young patients with high-risk,high-intermediate-risk aggressive B-NHL,and it possess a certain effect for increasing CR rate after transplantation.
闫蓓;李晓红;汪海涛;李松威;高亚会;张甜甜;王丽;吴亚妹;吴晓雄
解放军总医院第五医学中心血液病医学部,北京 100071
预处理方案自体造血干细胞移植B细胞非霍奇金淋巴瘤生存分析复发率
conditioning regimentautologous hematopoietic stem cell transplantationB cell non-Hodgkin's lymphomasurvival analysisrelapse rate
《解放军医学院学报》 2024 (002)
152-157 / 6
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