State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
Tianjin Institutes of Health Science, Tianjin, China.
Cancer Med. 2024 Jan;13(2):e6965. doi: 10.1002/cam4.6965.
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains an effective treatment for non-Hodgkin lymphoma (NHL). The limited availability of carmustine has prompted the exploration of novel alternative conditioning regimens. This study aimed to compare the efficacy and safety profile of GBM/GBC (gemcitabine, busulfan, and melphalan or cyclophosphamide) conditioning compared with the standard BEAM/BEAC regimens (carmustine, etoposide, cytarabine, and melphalan or cyclophosphamide) for ASCT in patients with NHL.
A retrospective analysis was conducted on 231 NHL patients, who underwent ASCT from October 2010 to October 2021 at the Institute of Hematology & Blood Disease Hospital, including both first-line and salvage settings. This resulted in the inclusion of 112 patients in the GBM/GBC arm and 92 in the BEAM/BEAC arm. Propensity score matching was employed to validate the results.
Disease subtype distribution was similar between the GBM/GBC and BEAM/BEAC groups, with diffuse large B-cell lymphoma being the most common (58.9% vs. 58.7%), followed by PTCL (17.0% vs. 18.5%) and MCL (14.3% vs. 14.1%). At 3 months post-ASCT, complete response (CR) rates were comparable (GBM/GBC 93.5% vs. BEAM/BEAC 91.1%; p = 0.607). The 4-year progression-free survival (78.4% vs. 82.3%; p = 0.455) and 4-year overall survival (88.1% vs. 87.7%; p = 0.575) were also similar. Both groups exhibited low non-relapse mortality at 4 years (GBM/GBC 1.8% vs. BEAM/BEAC 3.5%; p = 0.790) with no transplant-related mortalities reported. The GBM/GBC cohort demonstrated a higher incidence of grade 3/4 oral mucositis and hepatic toxicity, whereas the BEAM/BEAC group had more frequent cases of bacteremia or sepsis (13 cases vs. 5 in GBM/GBC).
The GBM/GBC regimen is effective and well-tolerated, offering outcomes that are highly comparable to those in NHL patients conditioned with BEAM/BEAC, as demonstrated in a prognostically matched cohort.
高剂量化疗后自体干细胞移植（ASCT）仍然是治疗非霍奇金淋巴瘤（NHL）的有效方法。卡莫司汀的供应有限，促使人们探索新的替代预处理方案。本研究旨在比较 GBM/GBC（吉西他滨、白消安和马法兰或环磷酰胺）与标准 BEAM/BEAC（卡莫司汀、依托泊苷、阿糖胞苷和马法兰或环磷酰胺）预处理在 NHL 患者 ASCT 中的疗效和安全性。
对 2010 年 10 月至 2021 年 10 月在血液病医院接受 ASCT 的 231 例 NHL 患者进行回顾性分析，包括一线和挽救性治疗。其中 112 例患者接受 GBM/GBC 预处理，92 例患者接受 BEAM/BEAC 预处理。采用倾向评分匹配验证结果。
GBM/GBC 组和 BEAM/BEAC 组的疾病亚型分布相似，弥漫性大 B 细胞淋巴瘤最常见（58.9% vs. 58.7%），其次是间变性大细胞淋巴瘤（17.0% vs. 18.5%）和套细胞淋巴瘤（14.3% vs. 14.1%）。ASCT 后 3 个月，完全缓解（CR）率相似（GBM/GBC 93.5% vs. BEAM/BEAC 91.1%；p=0.607）。4 年无进展生存（78.4% vs. 82.3%；p=0.455）和 4 年总生存（88.1% vs. 87.7%；p=0.575）也相似。两组 4 年非复发死亡率均较低（GBM/GBC 1.8% vs. BEAM/BEAC 3.5%；p=0.790），均无移植相关死亡。GBM/GBC 组口腔黏膜炎和肝毒性发生率较高（3/4 级），而 BEAM/BEAC 组菌血症或败血症发生率较高（13 例 vs. GBM/GBC 组 5 例）。
GBM/GBC 方案有效且耐受性良好，在预后匹配队列中，与 NHL 患者接受 BEAM/BEAC 预处理的结果高度可比。
