Chae Y S, Sohn S K, Kim J G, Cho Y Y, Moon J H, Shin H J, Chung J S, Cho G J, Yang D H, Lee J-J, Kim Y-K, Kim H-J
1Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea.
Bone Marrow Transplant. 2007 Sep;40(6):541-7. doi: 10.1038/sj.bmt.1705770. Epub 2007 Jul 16.
A regimen of busulfan and cyclophosphamide (BuCy2) is regarded as the standard myeloablative regimen for SCT. This study evaluated the hypothesis that fludarabine can replace cyclophosphamide for myeloablative allogeneic SCT. Ninety-five patients underwent allogeneic SCT from HLA-identical donors, following BuCy2 (n=55) or busulfan+fludarabine (BF, n=40). The efficacy of fludarabine compared to cyclophosphamide was retrospectively evaluated. The BF group exhibited a shorter duration until engraftment (P=0.001), lower incidence of acute and chronic GVHD (P<0.001 and P=0.003, respectively), and non-relapse mortality (NRM) (P=0.039). Furthermore, the event-free survival and overall survival were significantly higher for the BF group compared to the BuCy2 group (P=0.004 and 0.002, respectively). After adjusting for age, the risk status of disease, GVHD prophylaxis and donor type, the BF regimen was found to be an independent favorable risk factor for event-free survival (hazard ratio (HR), 0.181; 95% confidence interval, 0.045-0.720; P=0.016) and overall survival (HR, 0.168; 0.035-0.807; P=0.026). The replacement of cyclophosphamide with fludarabine for myeloablative conditioning seems to be more effective in terms of short-term NRM, and GVHD compared to BuCy2 regimen in allogeneic transplantation.
白消安和环磷酰胺（BuCy2）方案被视为异基因造血干细胞移植（SCT）的标准清髓方案。本研究评估了氟达拉滨可替代环磷酰胺用于清髓性异基因SCT的假说。95例患者接受了来自 HLA 配型相合供者的异基因SCT，其中55例采用 BuCy2方案，40例采用白消安+氟达拉滨（BF）方案。回顾性评估了氟达拉滨与环磷酰胺相比的疗效。BF组移植后造血重建时间较短（P=0.001），急慢性移植物抗宿主病（GVHD）发生率较低（分别为P<0.001和P=0.003），非复发死亡率（NRM）也较低（P=0.039）。此外，BF组的无事件生存率和总生存率显著高于BuCy2组（分别为P=0.004和0.002）。在调整年龄、疾病风险状态、GVHD预防措施和供者类型后，发现BF方案是无事件生存（风险比（HR），0.181；95%置信区间，0.045-0.720；P=0.016）和总生存（HR，0.168；0.035-0.807；P=0.026）的独立有利风险因素。在异基因移植中，与BuCy2方案相比，用氟达拉滨替代环磷酰胺进行清髓预处理在短期NRM和GVHD方面似乎更有效。
