氟达拉滨-苯达莫司汀预处理联合移植后环磷酰胺在经典型霍奇金淋巴瘤中异基因造血干细胞移植的良好结局。
Favorable outcomes of allogeneic hematopoietic stem cell transplantation with fludarabine-bendamustine conditioning and posttransplantation cyclophosphamide in classical Hodgkin lymphoma.
机构信息
Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia.
出版信息
Int J Hematol. 2022 Sep;116(3):401-410. doi: 10.1007/s12185-022-03355-3. Epub 2022 May 5.
INTRODUCTION
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for patients with relapsed and refractory classic Hodgkin lymphoma (rrHL). However, the optimal conditioning regimen and GVHD prophylaxis for rrHL remain undetermined. The aim of this study was to investigate outcomes of allo-HSCT with a fludarabine plus bendamustine (FluBe) conditioning regimen and GVHD prophylaxis with posttransplantation cyclophosphamide (PTCY) in patients with rrHL.
METHODS
Allo-HSCT results in 58 adult patients with rrHL were analyzed retrospectively.
RESULTS
Three-year overall survival and event-free survival were 81% (95% CI 65-91) and 55% (95% CI 38-72), respectively. The cumulative incidence of relapse (CIR) at 3 years was 33% (95% CI 13-51). The cumulative incidence of aGVHD grade II-IV and severe aGVHD grade III-IV was 36% (95% CI 22-48) and 22% (95% CI 9-33), respectively. The cumulative incidence of cGVHD was 32% (95% CI 17-45), including moderate or severe cGVHD in 17% (95% CI 4-28). Patients who developed aGVHD after allo-HSCT had significantly lower CIR (24% vs 49%, p = 0.004). The use of PBSC as a graft source also significantly reduced CIR (4% vs 61%, p = 0.002).
CONCLUSIONS
FluBe-PTCY allo-HSCT facilitates favorable outcomes, low toxicity, and mortality in rrHL.
简介
异基因造血干细胞移植（allo-HSCT）是治疗复发/难治性经典霍奇金淋巴瘤（rrHL）患者的一种潜在根治方法。然而，rrHL 的最佳预处理方案和移植物抗宿主病（GVHD）预防方案仍未确定。本研究旨在探讨氟达拉滨联合苯达莫司汀（FluBe）预处理方案联合移植后环磷酰胺（PTCY）预防 GVHD 用于 rrHL 患者的 allo-HSCT 结果。
方法
回顾性分析 58 例 rrHL 成人患者的 allo-HSCT 结果。
结果
3 年总生存率和无事件生存率分别为 81%（95%CI 65-91）和 55%（95%CI 38-72）。3 年累积复发率（CIR）为 33%（95%CI 13-51）。Ⅱ-Ⅳ级和重度Ⅲ-Ⅳ级急性 GVHD 的累积发生率分别为 36%（95%CI 22-48）和 22%（95%CI 9-33）。慢性 GVHD 的累积发生率为 32%（95%CI 17-45），其中中重度慢性 GVHD 发生率为 17%（95%CI 4-28）。allo-HSCT 后发生急性 GVHD 的患者 CIR 显著降低（24%比 49%，p=0.004）。使用 PBSC 作为移植物来源也显著降低了 CIR（4%比 61%，p=0.002）。
结论
FluBe-PTCY allo-HSCT 可为 rrHL 患者带来良好的预后、低毒性和低死亡率。
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