Salar A, Sierra J, Gandarillas M, Caballero M D, Marín J, Lahuerta J J, García-Conde J, Arranz R, León A, Zuazu J, García-Laraña J, López-Guillermo A, Sanz M A, Grañena A, García J C, Conde E
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Bone Marrow Transplant. 2001 Feb;27(4):405-12. doi: 10.1038/sj.bmt.1702795.
We investigated the impact of the most commonly used preparative regimens on the outcome of 395 patients with diffuse large cell lymphoma (DLCL), consecutively reported to the registry of the Spanish GEL/TAMO. Among them, 139 (35%) were autografted in 1st CR, 86 (22%) in 2nd/3rd CR, 124 (31%) had chemosensitive disease and 46 (12%) had chemoresistant disease. Conditioning consisted of chemotherapy-only in 348 patients (BEAM, 164; BEAC, 145; and CBV, 39) and radiochemotherapy with CY and TBI in 47. Median times to granulocyte, platelet recovery and to discharge were significantly shorter in the chemotherapy-only group. Early transplant-related mortality was significantly higher when using CY-TBI. After a median follow-up of 28 months, overall survival (OS) at 8 years of patients conditioned with BEAM or BEAC (58% (95% CI 50-66%)) was more favorable than with CBV (40% (95% CI 24-56%)), and significantly better than with CY-TBI (31% (95% CI 18-44%)). Multivariate analysis revealed that patients conditioned with chemotherapy-only regimens had improved OS, disease-free (DFS) and relapse-free survival (RFS) when compared to those conditioned with CY-TBI. Status at transplant was also a powerful prognostic indicator. We conclude that preparative regimens consisting of chemotherapy-only seem more efficacious than CY-TBI as conditioning for DLCL, because of faster engraftment and greater anti-lymphoma effect, as indicated by improved OS, DFS and RFS.
我们调查了最常用预处理方案对395例弥漫性大细胞淋巴瘤（DLCL）患者预后的影响，这些患者连续被纳入西班牙GEL/TAMO登记处。其中，139例（35%）在首次完全缓解（CR）时接受自体造血干细胞移植，86例（22%）在第二次/第三次CR时接受移植，124例（31%）患有化疗敏感疾病，46例（12%）患有化疗耐药疾病。348例患者的预处理仅包括化疗（BEAM方案164例、BEAC方案145例、CBV方案39例），47例患者接受环磷酰胺（CY）和全身照射（TBI）的放化疗。仅化疗组中性粒细胞、血小板恢复时间及出院时间的中位数明显更短。使用CY-TBI时早期移植相关死亡率明显更高。中位随访28个月后，接受BEAM或BEAC预处理的患者8年总生存率（OS）为58%（95%可信区间50-66%），优于接受CBV预处理的患者（40%（95%可信区间24-56%）），且明显优于接受CY-TBI预处理的患者（31%（95%可信区间18-44%））。多变量分析显示，与接受CY-TBI预处理的患者相比，接受仅化疗预处理方案的患者OS、无病生存率（DFS）和无复发生存率（RFS）均有所改善。移植时的状态也是一个有力的预后指标。我们得出结论，对于DLCL的预处理，仅化疗的预处理方案似乎比CY-TBI更有效，因为其植入更快且抗淋巴瘤效果更强，这体现在OS、DFS和RFS的改善上。
