Gunes Ahmet Kursad, Dagdas Simten, Ceran Funda, Ucar Mehmet Ali, Falay Mesude, Sunu Cenk, Ayli Meltem, Zengin Nurullah, Ozet Gulsum
Department of Hematology and Bone Marrow Transplantation, Ankara City Hospital, Universiteler Avenue Bilkent Street. No:1, 06800 Çankaya, Ankara, Turkey.
Department of Hematology and Bone Marrow Transplantation, Ankara City Hospital, University of Health and Sciences, Ankara, Turkey.
Indian J Hematol Blood Transfus. 2021 Jan;37(1):82-89. doi: 10.1007/s12288-020-01317-5. Epub 2020 Jul 8.
There are different drug combinations and conditioning regimens in lymphoma transplants. However, no randomized data is available to demonstrate the superiority of any regimen and the optimal choice is unknown. In this analysis, we compared the efficacy, toxicity and the survival outcomes of the BEAM and the high dose ICE (hdICE) conditioning regimens in relapsed NHL and relapsed/refractory Hodgkin Lymphoma patients undergoing auto-SCT. 83 patients with relapsed/refractory HL or relapsed NHL who were treated with Auto-SCT between 2006 and 2016, were analyzed retrospectively. 52 patients (62.7%) received BEAM, while 31 patients (37.3%) received hdICE. Between two groups there is no significant difference in age, gender, diagnosis, disease stage, chemosensitivity, ECOG performance status, time from diagnosis to transplant, salvage regimens and previous lines of chemotherapy. After a median of 59-month follow-up, PFS and OS rates of both groups were similar (5-year PFS was 51.6% in BEAM group, 48.8% in hdICE group, = 0.71; 5-year OS was 58% in BEAM group, 54.8% in hdICE group, = 0.93). The median neutrophil (11 vs. 10 days, = 0.06) and platelet engraftment (13 vs. 11 days, = 0.01) was faster and demand of transfusions were lesser in hdICE group ( = 0.03). However, severe renal toxicity was significantly higher in hdICE group in our study ( = 0.01). hdICE conditioning regimen may be used as an alternative to BEAM, with similar survival outcomes and toxicity profile, especially transplant centers that experience some difficulties in the availability of the carmustine.
淋巴瘤移植中有不同的药物组合和预处理方案。然而，尚无随机数据可证明任何方案的优越性，最佳选择也未知。在本分析中，我们比较了BEAM和大剂量ICE（hdICE）预处理方案在接受自体造血干细胞移植（auto-SCT）的复发非霍奇金淋巴瘤（NHL）和复发/难治性霍奇金淋巴瘤患者中的疗效、毒性和生存结果。回顾性分析了2006年至2016年间接受auto-SCT治疗的83例复发/难治性HL或复发NHL患者。52例患者（62.7%）接受BEAM方案，而31例患者（37.3%）接受hdICE方案。两组在年龄、性别、诊断、疾病分期、化疗敏感性、东部肿瘤协作组（ECOG）体能状态、从诊断到移植的时间、挽救方案和既往化疗疗程方面无显著差异。中位随访59个月后，两组的无进展生存期（PFS）和总生存期（OS）率相似（BEAM组5年PFS为51.6%，hdICE组为48.8%，P = 0.71；BEAM组5年OS为58%，hdICE组为54.8%，P = 0.93）。hdICE组中性粒细胞中位植入时间（11天对10天，P = 0.06）和血小板植入时间（13天对11天，P = 0.01）更快，输血需求更少（P = 0.03）。然而，在我们的研究中，hdICE组严重肾毒性显著更高（P = 0.01）。hdICE预处理方案可作为BEAM方案的替代方案，具有相似的生存结果和毒性特征，尤其是在卡莫司汀供应存在一些困难的移植中心。
