C+SCAV和SEAM两种预处理方案自体造血干细胞移植治疗非霍奇金淋巴瘤的疗效与安全性比较  

A comparison of C+SCAV and SEAM conditioning regimens in efficacy and safety in autologous hematopoietic stem cell transplantation for non-Hodgkin's lymphoma patients

作　　者：李嘉琦 张莹[1] 耿洪智 贾思寻 吴小津[1] 周进[1] 宗香萍 杨贞[1] 陈晓晨[1] 马超[1] 陈广华[1] 戴海萍[1] 李彩霞[1] 吴德沛[1] Li Jiaqi;Zhang Ying;Geng Hongzhi;Jia Sixun;Wu Xiaojin;Zhou Jin;Zong Xiangping;Yang Zhen;Chen Xiaochen;Ma Chao;Chen Guanghua;Dai Haiping;Li Caixia;Wu Depei(Jiangsu Institute of Hematology,The First Affiliated Hospital of Soochow University,National Clinical Research Center for Hematologic Diseases,Jiangsu Institute of Hematology,The First Affiliated Hospital of Soochow University,Institute of Blood and Marrow Transplantation,Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院血液科,江苏省血液研究所,国家血液系统疾病临床医学研究中心,苏州大学造血干细胞移植研究所,苏州215006

出　　处：《中华血液学杂志》2022年第8期668-673,共6页Chinese Journal of Hematology

摘　　要：目的比较C+SCAV(克拉屈滨+司莫司汀+环磷酰胺+阿糖胞苷+依托泊苷)和SEAM(司莫司汀+依托泊苷+阿糖胞苷+美法仑)两种预处理方案在非霍奇金淋巴瘤(NHL)患者自体造血干细胞移植(auto-HSCT)中的疗效与安全性。方法对2018年3月至2021年5月期间在苏州大学附属第一医院血液科接受auto-HSCT的61例NHL患者进行回顾性分析。结果①61例NHL患者中,男37例,女24例;中位年龄48(21~66)岁,C+SCAV方案组19例,SEAM方案组42例,两组在基线特征方面差异无统计学意义(P>0.05)。②C+SCAV组、SEAM组中性粒细胞植入中位时间分别为10(8~15)d、9(7~16)d(P=0.103),血小板植入的中位时间分别为13(9~22)d、12(7~30)d(P=0.403),差异均无统计学意义。③C+SCAV组、SEAM组移植后1年无进展生存(PFS)率分别为(76.5±10.3)%、(78.4±6.8)%(P=0.841),总生存(OS)率分别为100.0%、(95.2±3.3)%(P=0.339)。④对于移植前达完全缓解(CR)状态的患者,C+SCAV组、SEAM组移植后1年PFS率分别为(92.3±7.4)%、(82.5±7.2)%(P=0.406)。⑤C+SCAV组、SEAM组非血液系统严重不良反应(≥3级)发生率分别为10.5%(2/19)、40.5%(17/42)(P=0.013),严重黏膜炎的发生率分别为5.3%(1/19)、31.0%(13/42)(P=0.015),严重感染(≥3级)的发生率分别为10.5%(2/19)、19.0%(8/42)(P=0.389)。结论采用C+SCAV预处理方案auto-HSCT治疗NHL患者可获得与SEAM预处理方案相似的移植后1年后生存率,非血液系统严重不良反应发生率较低且不会增加严重感染的风险。Objective This study aimed to compare the efficacy and safety of cladribine,smustine,etoposide,cyclophosphamide,and cytarabine(C+SCAV)and smustine,etoposide,cytarabine,and melphalan(SEAM)conditioning regimens in autologous stem cell transplantation(auto-HSCT)for non-Hodgkin’s lymphoma(NHL).Methods A retrospective analysis was conducted on 61 NHL patients who received auto-HSCT in the Department of Hematology,the First Affiliated Hospital of Suzhou University,from March 2018 to May 2021.The C+SCAV group and SEAM group had 19 and 42 patients,respectively.Results①Among the 61 patients with NHL,37 were male and 24 were female.The median age was 48(21-66)years old.There were 19 cases in the C+SCAV group and 42 cases in the SEAM group.There was no significant difference in the baseline characteristics between the two groups(P>0.05).②The median time to neutrophil and platelet engraftment in the C+SCAV cohort were 10(8-15)days and 13(9-22)days,respectively,which does not differ from the SEAM group(P=0.103,P=0.403).③No differences existed between the two groups in terms of survival.The 1-year progression-free survival(PFS)was(76.5±10.3)%for patients receiving C+SCAV and(78.4±6.8)%for those who received SEAM(P=0.841).The 1-year overall survival was 100.0%for the C+SCAV group and 95.2±3.3%for the SEAM group(P=0.339).④The 1-year PFS of patients with complete remission in the C+SCAV group was similar to those who in the SEAM group[(92.3±7.4)%vs(82.5±7.2)%,P=0.406].⑤The incidence of non-hematological serious adverse events(≥grade 3)in the C+SCAV group and SEAM group were 10.5%(2/19)and 40.5%(17/42)(P=0.013),the incidence of severe mucositis was 5.3%(1/19)and 31.0%(13/42)(P=0.015),and the incidence of severe infection(≥grade 3)was 10.5%(2/19)and 19.0%(8/42)(P=0.389),respectively.Conclusion C+SCAV conditioning regimen appeared to be no different from the SEAM regimen in terms of survival.It can lower the incidence of SAE and does not increase the risk of severe infection.As a result,it can be used as an alte

关 键 词：克拉屈滨 自体造血干细胞移植 预处理 非霍奇金淋巴瘤 

分 类 号：R733.1[医药卫生—肿瘤]