Brammer Jonathan E, Khouri Issa, Gaballa Sameh, Anderlini Paolo, Tomuleasa Ciprian, Ahmed Sairah, Ledesma Celina, Hosing Chitra, Champlin Richard E, Ciurea Stefan O
Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas.
Biol Blood Marrow Transplant. 2016 Mar;22(3):493-8. doi: 10.1016/j.bbmt.2015.10.015. Epub 2015 Oct 20.
Haploidentical transplantation (Haplo-SCT) with post-transplantation cyclophosphamide (PTCy) is increasingly utilized for the treatment of lymphoma and almost exclusively with the nonmyeloablative fludarabine (Flu)/cyclophosphamide/total body irradiation (TBI) conditioning regimen. We present early results of a reduced-intensity (RIC) regimen utilizing fludarabine and melphalan (FM) for the treatment of advanced lymphoma. All patients with a diagnosis of lymphoma or chronic lymphocytic leukemia (CLL) who received Haplo-SCT at the University of Texas MD Anderson Cancer Center between 2009 and 2014 were reviewed (N = 22). Patients received Flu 160 mg/m(2) and melphalan 100 mg/m(2) to 140 mg/m(2) with thiotepa 5 mg/kg or 2 Gy TBI. Because of concerns of increased treatment-related mortality (TRM) with the melphalan 140 mg/m(2) regimen (FM140), a RIC regimen with melphalan 100 mg/m(2) (FM100) was devised. Rituximab was included for CD20(+) disease. Graft-versus-host disease prophylaxis consisted of PTCy 50 mg/kg on days +3 and + 4, tacrolimus, and mycophenolate mofetil. Sixty-eight percent of all patients were not in complete remission at the time of transplantation. The 2-year progression-free survival (PFS) and overall survival (OS) for the entire cohort were 54%, 1-year TRM was 19%, and the cumulative incidence of relapse at 2 years was 27%. Two-year PFS for Hodgkin lymphoma, non-Hodgkin lymphoma, and CLL/small lymphocytic lymphoma were 57%, 51%, and 75%. Patients treated with FM100 compared to FM140 had equivalent PFS (71% versus 37%, P = .246) and OS (71% versus 58%, P = .32). These early results establish Flu and melphalan 100 mg/m(2) with 2 Gy TBI or thiotepa 5 mg/kg as a very promising conditioning regimen for the treatment of advanced lymphoma with Haplo-SCT and PTCy.
伴移植后环磷酰胺（PTCy）的单倍型同基因移植（Haplo-SCT）越来越多地用于淋巴瘤治疗，并且几乎仅与非清髓性氟达拉滨（Flu）/环磷酰胺/全身照射（TBI）预处理方案联合使用。我们展示了利用氟达拉滨和美法仑（FM）的降低强度（RIC）方案治疗晚期淋巴瘤的早期结果。回顾了2009年至2014年期间在德克萨斯大学MD安德森癌症中心接受Haplo-SCT的所有淋巴瘤或慢性淋巴细胞白血病（CLL）诊断患者（N = 22）。患者接受氟达拉滨160 mg/m²和美法仑100 mg/m²至140 mg/m²，联合噻替派5 mg/kg或2 Gy TBI。由于担心美法仑140 mg/m²方案（FM140）会增加治疗相关死亡率（TRM），设计了美法仑100 mg/m²的RIC方案（FM100）。对于CD20阳性疾病，加入利妥昔单抗。移植物抗宿主病预防包括在+3天和+4天给予PTCy 50 mg/kg、他克莫司和霉酚酸酯。所有患者中有68%在移植时未完全缓解。整个队列的2年无进展生存期（PFS）和总生存期（OS）分别为54%，1年TRM为19%，2年复发累积发生率为27%。霍奇金淋巴瘤、非霍奇金淋巴瘤和CLL/小淋巴细胞淋巴瘤的2年PFS分别为57%、51%和75%。与FM140相比，接受FM100治疗的患者具有相当的PFS（71%对37%，P = 0.246）和OS（71%对58%，P = 0.32）。这些早期结果表明，氟达拉滨和美法仑100 mg/m²联合2 Gy TBI或噻替派5 mg/kg是一种非常有前景的预处理方案，用于Haplo-SCT和PTCy治疗晚期淋巴瘤。
