Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Biol Blood Marrow Transplant. 2019 Jul;25(7):1340-1346. doi: 10.1016/j.bbmt.2019.02.002. Epub 2019 Feb 11.
We analyzed 186 patients with lymphoma who underwent allogeneic stem cell transplantation (ASCT) with fludarabine-melphalan (FM) conditioning and different types of donors (25 haploidentical [HD], 98 matched unrelated [MUD], and 63 matched related [MRD]) at our institution between September 2009 and January 2018. Patients received fludarabine 160 mg/m (40 mg/m/day for 4 days) in combination with 1 dose of melphalan 140 mg/m (FM140) or 100 mg/m (FM100). Engraftment was similar among the 3 groups (92%, 89%, and 98%, respectively; P = .7). The 6-month cumulative incidence of grade III-IV acute graft-versus-host disease (GVHD) was 4% in the HD group, 14% in the MUD group, and 8% in the MRD group (P not significant), and the respective 3-year cumulative incidence of chronic GVHD was 5%, 16%, and 26% (P not significant). The respective 3-year nonrelapse mortality and relapse rates were 31%, 32%, and 10% (HD versus MUD, P = .9; HD versus MRD, P = .02) and 15%, 21%, and 39% (HD versus MUD, P = .4; HD versus MRD, P = .04). At 3 years, progression-free survival (PFS) was 59%, 44%, and 46% (P not significant); overall survival (OS) was 52%, 54%, and 67% (P not significant); and GVHD-free, relapse-free survival was 39%, 31%, and 24% (P not significant). No differences in the 3-year PFS (57% versus 43%; P = .3) and OS (64% versus 58%; P = .7) were seen between patients receiving FM100 and those receiving FM140. Our data demonstrate that in patients with lymphoma, ASCT with HD transplants have similar outcomes as ASCT with HLA-matched transplants, and the FM100 conditioning regimen appears to be at least as effective as the FM140 regimen.
我们分析了 2009 年 9 月至 2018 年 1 月在我院接受氟达拉滨-美法仑（FM）预处理和不同类型供体（25 例单倍体[HD]、98 例匹配无关[MUD]和 63 例匹配相关[MRD]）的 186 例淋巴瘤患者的资料。患者接受氟达拉滨 160mg/m2（40mg/m2，连用 4 天）联合美法仑 140mg/m2（FM140）或 100mg/m2（FM100）1 剂。3 组患者的植入情况相似（分别为 92%、89%和 98%；P=0.7）。HD 组、MUD 组和 MRD 组 6 个月时 3 级及以上急性移植物抗宿主病（GVHD）的累积发生率分别为 4%、14%和 8%（P 无统计学意义），3 年时慢性 GVHD 的累积发生率分别为 5%、16%和 26%（P 无统计学意义）。3 年时非复发死亡率和复发率分别为 31%、32%和 10%（HD 与 MUD 相比，P=0.9；HD 与 MRD 相比，P=0.02）和 15%、21%和 39%（HD 与 MUD 相比，P=0.4；HD 与 MRD 相比，P=0.04）。3 年时无进展生存率（PFS）分别为 59%、44%和 46%（P 无统计学意义）；总生存率（OS）分别为 52%、54%和 67%（P 无统计学意义）；GVHD 无复发-复发生存率分别为 39%、31%和 24%（P 无统计学意义）。接受 FM100 预处理和接受 FM140 预处理的患者，3 年时 PFS（57%与 43%；P=0.3）和 OS（64%与 58%；P=0.7）均无差异。我们的数据表明，在淋巴瘤患者中，HD 移植与 HLA 匹配移植具有相似的结果，而 FM100 预处理方案似乎至少与 FM140 方案一样有效。
