氟达拉滨和白消安与氟达拉滨、环磷酰胺和利妥昔单抗作为滤泡性淋巴瘤异基因移植的低强度预处理方案。
Fludarabine and Busulfan versus Fludarabine, Cyclophosphamide, and Rituximab as Reduced-Intensity Conditioning for Allogeneic Transplantation in Follicular Lymphoma.
机构信息
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology, The Ohio State University Medical Center, Columbus, Ohio.
Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
出版信息
Biol Blood Marrow Transplant. 2018 Jan;24(1):78-85. doi: 10.1016/j.bbmt.2017.10.011. Epub 2017 Oct 13.
Large, multicenter studies comparing commonly used reduced-intensity conditioning (RIC) approaches in follicular lymphoma (FL) have not been performed. Using the Center for International Blood and Marrow Transplant Research database, we report the outcomes of the 2 most commonly used RIC approaches, fludarabine and busulfan (Flu/Bu) versus fludarabine, cyclophosphamide, and rituximab (FCR) in FL patients. We evaluated 200 FL patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who received RIC with either Flu/Bu (n = 98) or FCR (n = 102) during 2008 to 2014. All patients received peripheral blood grafts, and graft-versus-host disease (GVHD) prophylaxis was limited to calcineurin inhibitor-based approaches. Median follow-up of survivors in the Flu/Bu and FCR groups was 48 months and 46 months, respectively. On univariate analysis in the Flu/Bu and FCR groups, the 3-year rates of nonrelapse mortality (11% versus 11%, P = .94), relapse/progression (18% versus 15%, P = .54), progression-free survival (PFS) (71% versus 74%, P = .65), and overall survival (OS) (73% versus 81%, P = .18) were not significantly different. On multivariate analysis no difference was seen between the FCR and Flu/Bu cohorts in terms of grades II to IV (relative risk [RR], 1.06; 95% confidence interval [CI], .59 to 1.93; P = .84) or grades III to IV (RR, 1.18; 95% CI, .47 to 2.99; P = .72) acute GVHD, nonrelapse mortality (RR, .83; 95% CI, .38 to 1.82; P = .64), relapse/progression (RR, .99; 95% CI, .49 to 1.98; P = .97), PFS (RR, .92; 95% CI, .55 to 1.54; P = .76), or OS (RR, .70; 95% CI, .40 to 1.23; P = .21) risk. However, RIC with FCR was associated with a significantly reduced chronic GVHD risk (RR, .52; 95% CI, .36 to .77; P = .001). RIC with either Flu/Bu or FCR in patients with FL undergoing allo-HCT provides excellent 3-year OS, with acceptable rates of nonrelapse mortality. FCR-based conditioning was associated with a lower risk of chronic GVHD.
在滤泡性淋巴瘤（FL）中，尚未开展比较常用的减低强度预处理（RIC）方案的大型多中心研究。利用国际血液和骨髓移植研究中心数据库，我们报告了 FL 患者中 2 种最常用的 RIC 方法（氟达拉滨和白消安[Flu/Bu]与氟达拉滨、环磷酰胺和利妥昔单抗[FCR]）的结果。我们评估了 2008 年至 2014 年期间接受 RIC 的 200 例接受allo-HCT 的 FL 患者，他们分别接受了 Flu/Bu（n=98）或 FCR（n=102）。所有患者均接受了外周血移植物，移植物抗宿主病（GVHD）预防仅限于钙调神经磷酸酶抑制剂为基础的方法。在 Flu/Bu 和 FCR 组中，幸存者的中位随访时间分别为 48 个月和 46 个月。在 Flu/Bu 和 FCR 组的单变量分析中，3 年非复发死亡率（11%对 11%，P=0.94）、复发/进展（18%对 15%，P=0.54）、无进展生存期（PFS）（71%对 74%，P=0.65）和总生存期（OS）（73%对 81%，P=0.18）均无显著差异。多变量分析显示，在 FCR 和 Flu/Bu 队列中，2 至 4 级（相对风险[RR]，1.06；95%置信区间[CI]，.59 至 1.93；P=0.84）或 3 至 4 级（RR，1.18；95% CI，.47 至 2.99；P=0.72）急性 GVHD、非复发死亡率（RR，0.83；95% CI，.38 至 1.82；P=0.64）、复发/进展（RR，0.99；95% CI，.49 至 1.98；P=0.97）、PFS（RR，0.92；95% CI，.55 至 1.54；P=0.76）或 OS（RR，0.70；95% CI，.40 至 1.23；P=0.21）风险无差异。然而，FCR 为基础的预处理与慢性 GVHD 风险显著降低相关（RR，0.52；95% CI，0.36 至 0.77；P=0.001）。在接受 allo-HCT 的 FL 患者中，Flu/Bu 或 FCR 为基础的 RIC 均可提供优异的 3 年 OS，非复发死亡率可接受。基于 FCR 的预处理与慢性 GVHD 风险降低有关。
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