Isidori Alessandro, Christofides Anna, Visani Giuseppe
a Haematology and Haematopoietic Stem Cell Transplant Center, AORMN , Pesaro , Italy ;
b IMPACT Medicom Inc. , Toronto , ON , Canada.
Leuk Lymphoma. 2016 Nov;57(11):2499-509. doi: 10.1080/10428194.2016.1185785. Epub 2016 May 31.
High-dose therapy (HDT) followed by autologous stem cell transplant (ASCT) is the standard treatment for relapsed or refractory non-Hodgkin and Hodgkin lymphoma. Until recently, carmustine, etoposide, cytarabine and melphalan (BEAM) was the most commonly used conditioning regimen in this setting, given its acceptable efficacy and tolerability. Despite reasonable success with BEAM, carmustine is associated with a number of acute and late toxicities. Moreover, recent supply and cost issues for this agent have created an urgent need for alternative conditioning regimens. As such, etoposide and melphalan (VP16/MEL) or busulfan, cyclophosphamide, and etoposide (BuCyE) are currently being used with limited success. A number of novel conditioning regimens that replace carmustine with other agents are under investigation, which may provide effective alternatives to BEAM. In considering novel agents to replace carmustine, bendamustine may provide the best alternative, as demonstrated by the results of a number of phase II, multicenter, controlled studies.
大剂量疗法(HDT)联合自体干细胞移植(ASCT)是复发或难治性非霍奇金淋巴瘤和霍奇金淋巴瘤的标准治疗方法。直到最近,卡莫司汀、依托泊苷、阿糖胞苷和美法仑(BEAM)仍是这种情况下最常用的预处理方案,因其疗效和耐受性尚可。尽管BEAM取得了一定成功,但卡莫司汀与多种急性和晚期毒性相关。此外,该药物近期的供应和成本问题迫切需要替代的预处理方案。因此,目前使用的依托泊苷和美法仑(VP16/MEL)或白消安、环磷酰胺和依托泊苷(BuCyE)效果有限。一些用其他药物替代卡莫司汀的新型预处理方案正在研究中,可能会为BEAM提供有效的替代方案。在考虑用新型药物替代卡莫司汀时,苯达莫司汀可能是最佳选择,多项II期多中心对照研究结果已证明了这一点。