Bryant A, Nivison-Smith I, Pillai E S, Kennedy G, Kalff A, Ritchie D, George B, Hertzberg M, Patil S, Spencer A, Fay K, Cannell P, Berkahn L, Doocey R, Spearing R, Moore J
St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
Australasian Bone Marrow Transplant Recipient Registry, New South Wales, Sydney, Australia.
Bone Marrow Transplant. 2014 Jan;49(1):17-23. doi: 10.1038/bmt.2013.142. Epub 2013 Sep 23.
This was an Australasian Bone Marrow Transplant Recipient Registry (ABMTRR)-based retrospective study assessing the outcome of Fludarabine Melphalan (FluMel) reduced-intensity conditioning between 1998 and 2008. Median follow-up was 3.4 years. There were 344 patients with a median age of 54 years (18-68). In all, 234 patients had myeloid malignancies, with AML (n=166) being the commonest indication. There were 110 lymphoid patients with non-hodgkins lymphoma (NHL) (n=64) the main indication. TRM at day 100 was 14% with no significant difference between the groups. OS and disease-free survival (DFS) were similar between myeloid and lymphoid patients (57 and 50% at 3 years, respectively). There was no difference in cumulative incidence of relapse or GVHD between groups. Multivariate analysis revealed four significant adverse risk factors for DFS: donor other than HLA-identical sibling donor, not in remission at transplant, previous autologous transplant and recipient CMV positive. Chronic GVHD was associated with improved DFS in multivariate analysis predominantly due to a marked reduction in relapse (HR:0.44, P=0.003). This study confirms that FluMel provides durable and equivalent remissions in both myeloid and lymphoid malignancies. Disease stage and chronic GVHD remain important determinants of outcome for FluMel allografting.
这是一项基于澳大拉西亚骨髓移植受者登记处（ABMTRR）的回顾性研究，评估了1998年至2008年间氟达拉滨美法仑（FluMel）减低强度预处理的结果。中位随访时间为3.4年。共有344例患者，中位年龄为54岁（18 - 68岁）。其中，234例患者患有髓系恶性肿瘤，急性髓系白血病（AML，n = 166）是最常见的适应证。有110例淋巴系患者，主要适应证为非霍奇金淋巴瘤（NHL，n = 64）。100天时的移植相关死亡率（TRM）为14%，两组之间无显著差异。髓系和淋巴系患者的总生存期（OS）和无病生存期（DFS）相似（3年时分别为57%和50%）。两组之间复发或移植物抗宿主病（GVHD）的累积发生率无差异。多因素分析显示DFS的四个显著不良风险因素：非HLA全相合同胞供者、移植时未缓解、既往自体移植和受者巨细胞病毒（CMV）阳性。多因素分析中慢性GVHD与DFS改善相关，主要是由于复发显著减少（风险比：0.44，P = 0.003）。本研究证实FluMel在髓系和淋巴系恶性肿瘤中均能提供持久且等效的缓解。疾病分期和慢性GVHD仍然是FluMel同种异体移植结局的重要决定因素。
