CY-fTBI与BMM预处理方案在异基因造血干细胞移植治疗Ⅲ、Ⅳ期非霍奇金淋巴瘤过程中的疗效：单中心15年分析
[Therapeutic effect of CY-fTBI and BMM conditioning regimen in the process of allo-HSCT treating Ⅲ,Ⅳ non-Hodgkin lymphoma: 15 years analysis of single-center].
作者信息
Sun Ting, Hu Liangding, Jiang Min, Ning Hongmei, Zhang Bin, Ren Jing, Li Yuhang, Li Botao, Chen Jianlin, Yang Fan, Xu Chen, Wang Jun, Lou Xiao, Hu Jiangwei, Chen Hu
机构信息
Institute of Hematology 307 PLA Hospital, Beijing 100071, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2015 Oct;36(10):830-4. doi: 10.3760/cma.j.issn.0253-2727.2015.10.005.
OBJECTIVE
To investigate the efficacy of allogeneic hematopoietic stem cell transplantation（allo-HSCT）in the treatment of patients with Ⅲ,Ⅳ non-Hodgkin lymphoma（NHL）, and compared the efficacy between Cy- fractionated to talbody irradiation（fTBI）based conditioning regimen and Maryland, horse flange and mitoxantrone（BMM）.
METHODS
The clinical data of 47 patients with Ⅲ, Ⅳ NHL after allo- HSCT from November 1998 to May 2014 were collected and retrospectively analyzed. To observe the hematopoietic reconstruction recovery after transplantation, cumulative incidence of acute graft- versus- host- disease （aGVHD） and chronic graft- versus- host- disease （cGVHD）, transplantation related mortality （TRM）, recurrence rate （RR）, disease- free survival （DFS）, overall survival（OS）. Compare the efficacy of fTBI and BMM conditioning regimen at the same time.
RESULTS
Neutrophils achieving 0.5×10⁹/L and platelets achieving 50×10⁹/L on day 17 （range, 10- 72） post transplantation. Acute GVHD occurred in 53.19%, among them, grade Ⅰ-Ⅱ occurred in 42.55%, grade Ⅲ-Ⅳ occurred in 10.65%, and cGVHD occurred in 21.28%. 21 patients were alive with a median follow up of 9.7 months（0.2-149.1 months）. Overall survival（OS）was 73.5%, 49.3%, 40.1% respectively in the first, third and fifth year in Cy-fTBI group; in BMM group it was 67.8%, 32.9% and 31.4% respectively, and disease-free survival（DFS）was 65.3%, 45.6%, 30.2% respectively in the first, third and fifth year. In Cy-fTBI group, the recurrence rate（RR）and transplantation related mortality（TRM）in the first year were 18.9%, 23.0% respectively, the third year were 19.5%, 38.3% and the fifth year were 35.2%, 39.2%. In BMM group, RR and TRM in the first year were 27.4%, 24.5% respectively, the third year were 38.9%, 46.4% and the fifth year were 39.2%, 48.2%. However, there was no significant difference in the indicator of OS, DFS, RR, TRM in the two groups.
CONCLUSION
Allo-HSCT could make some Ⅲ,Ⅳ NHL patients achieve long-term disease- free survival, but the TRM was still high relatively. Moreover, compared with the program of BMM conditioning regimen, Cy-fTBI might reduce the TRM and RR, meanwhile, increase the DFS and OS. However, due to the small number cases of two groups, there was no statistical significant difference.
目的
探讨异基因造血干细胞移植（allo-HSCT）治疗Ⅲ、Ⅳ期非霍奇金淋巴瘤（NHL）患者的疗效，并比较基于环磷酰胺分次全身照射（fTBI）的预处理方案与马法兰、阿糖胞苷和米托蒽醌（BMM）方案的疗效。
方法
收集1998年11月至2014年5月行allo-HSCT的47例Ⅲ、Ⅳ期NHL患者的临床资料并进行回顾性分析。观察移植后造血重建恢复情况、急性移植物抗宿主病（aGVHD）和慢性移植物抗宿主病（cGVHD）的累积发生率、移植相关死亡率（TRM）、复发率（RR）、无病生存率（DFS）、总生存率（OS）。同时比较fTBI和BMM预处理方案的疗效。
结果
移植后第17天（范围10 - 72天）中性粒细胞达0.5×10⁹/L，血小板达50×10⁹/L。急性GVHD发生率为53.19%，其中Ⅰ - Ⅱ级发生率为42.55%，Ⅲ - Ⅳ级发生率为10.65%，慢性GVHD发生率为21.28%。21例患者存活，中位随访时间为9.7个月（0.2 - 149.1个月）。Cy-fTBI组1年、3年、5年总生存率（OS）分别为73.5%、49.3%、40.1%；BMM组分别为67.8%、32.9%、31.4%，无病生存率（DFS）1年、3年、5年分别为65.3% 、45.6%、30.2%。Cy-fTBI组1年复发率（RR）和移植相关死亡率（TRM）分别为18.9%、23.0%，3年分别为19.5%、38.3%，5年分别为35.2%、39.2%。BMM组1年RR和TRM分别为27.4%、24.5%，3年分别为38.9%、46.4%，5年分别为39.2%、48.2%。然而，两组OS、DFS、RR、TRM指标差异无统计学意义。
结论
allo-HSCT可使部分Ⅲ、Ⅳ期NHL患者获得长期无病生存，但TRM仍相对较高。此外，与BMM预处理方案相比，Cy-fTBI可能降低TRM和RR，同时提高DFS和OS。但由于两组病例数较少，差异无统计学意义。
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