Auger-Quittet Sophie, Duny Yohan, Daures Jean-Pierre, Quittet Philipe
Department of Internal Medicine, Mutualist Clinic Beausoleil, Montpellier, France.
Cancer Med. 2014 Aug;3(4):927-38. doi: 10.1002/cam4.247. Epub 2014 Apr 16.
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard therapy in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) who are chemosensitive. The combination of carmustine, etoposide, cytarabine, and melphalan (BEAM) is commonly used as a conditioning regimen. The addition of yttrium-90 ((90) Y)-ibritumomab tiuxetan (Zevalin(®)) to BEAM (Z-BEAM) is increasingly being used to improve outcomes and overcome refractory disease. We conducted a literature review and meta-analysis in order to evaluate the clinical effects of Z-BEAM followed by ASCT in patients with DLBCL. A literature search was conducted for randomized controlled trials and observational studies of Z-BEAM as a conditioning regimen for ASCT in adult patients with DLBCL. Extracted data included baseline patient demographics, overall response (ORR), complete response (CR), overall survival (OS), progression-free survival (PFS), nonrelapse mortality (NRM), median time to ANC and platelet engraftment, and rate of myelodysplastic syndrome. Mixed-effects models were used to determine estimates. Ten studies (N = 328) were included in the meta-analysis. The 2-year OS and PFS were 84.5% (n = 328) and 67.2% (n = 285), respectively. Outcomes were superior in patients with nontransformed lymphoma. Posttransplant, ORR and CR rates were 72.6% and 68.5%, respectively. The NRM rate was 6.3% and the incidence rate of myelodysplastic syndrome was 2.5%. Two-year OS was significantly associated with pretransplant ORR (P = 0.008, τ(2) = 0). There was no significant association between PFS and pretransplant response. Z-BEAM is safe and effective as a conditioning regimen in relapsed/refractory DLBCL.
大剂量化疗后进行自体干细胞移植（ASCT）是复发/难治性弥漫性大B细胞淋巴瘤（DLBCL）且对化疗敏感患者的标准治疗方法。卡莫司汀、依托泊苷、阿糖胞苷和美法仑（BEAM）联合方案通常用作预处理方案。在BEAM方案（Z - BEAM）中加入钇 - 90（90Y）- 替伊莫单抗（泽瓦林（Zevalin®））越来越多地用于改善疗效和克服难治性疾病。我们进行了一项文献综述和荟萃分析，以评估Z - BEAM方案后进行ASCT对DLBCL患者的临床效果。对关于Z - BEAM作为成年DLBCL患者ASCT预处理方案的随机对照试验和观察性研究进行了文献检索。提取的数据包括患者基线人口统计学特征、总缓解率（ORR）、完全缓解率（CR）、总生存期（OS）、无进展生存期（PFS）、非复发死亡率（NRM）、中性粒细胞和血小板植入的中位时间以及骨髓增生异常综合征的发生率。采用混合效应模型来确定估计值。荟萃分析纳入了10项研究（N = 328）。2年总生存期和无进展生存期分别为84.5%（n = 328）和67.2%（n = 285）。非转化型淋巴瘤患者的预后更好。移植后，总缓解率和完全缓解率分别为72.6%和68.5%。非复发死亡率为6.3%，骨髓增生异常综合征的发生率为2.5%。2年总生存期与移植前总缓解率显著相关（P = 0.008，τ(2) = 0）。无进展生存期与移植前缓解情况无显著关联。Z - BEAM作为复发/难治性DLBCL的预处理方案安全有效。
