F/C+AIECy预处理方案在自体造血干细胞移植治疗侵袭性B细胞NHL中的疗效观察  

Effect of auto-HSCT using conditioning regimen F/C+AIECy for aggressive B cell NHL

作　　者：闫蓓 李晓红 汪海涛 李松威 高亚会 张甜甜 王丽 吴亚妹 吴晓雄 YAN Bei;LI Xiaohong;WANG Haitao;LI Songwei;GAO Yahui;ZHANG Tiantian;WANG Li;WU Yamei;WU Xiaoxiong(Institute of Hematology,the Fifth Medical Center,Chinese PLA General Hospital,Beijing 100071,China)

机构地区：[1]解放军总医院第五医学中心血液病医学部,北京100071

出　　处：《解放军医学院学报》2024年第2期152-157,共6页Academic Journal of Chinese PLA Medical School

摘　　要：背景自体造血干细胞移植(autologous hematopoietic stem cell transplantation,Auto-HSCT)在年轻高危险度分层的侵袭性B细胞非霍奇金淋巴瘤(B-cell non-Hodgkin’s lymphoma,B-NHL)患者治疗中作为一线巩固方案,逐渐成为国内外专家的共识。现行预处理方案下,依然有超过30%患者移植后复发,故预处理方案仍有改进空间。目的探究预处理方案为氟达拉滨或克拉屈滨联合阿糖胞苷+伊达比星+依托泊苷+环磷酰胺(F/C+AIECy)的自体造血干细胞移植一线巩固治疗高危、中高危侵袭性B-NHL的安全性和有效性。方法回顾性分析2015年1月—2020年1月我院应用本预处理方案的高危、中高危侵袭性B-NHL患者临床资料,分析干细胞采集情况、预处理相关不良反应、植入情况、患者疗效及生存与复发情况。结果共纳入32例患者,男20例,女12例,中位年龄42(范围:15~60)岁。采集单个核细胞和CD34+细胞的中位数分别为11.55(范围:8.05~14.76)×10^(8)/kg、4.56(范围:1.58~15.24)×10^(6)/kg。所有患者均获得造血重建,植入率为100%;白细胞植入的中位时间为10(范围:7~20)d,血小板植入的中位时间为14(范围:12~30)d。移植期间感染发生率为68.75%,其他2级及以上不良反应发生率:黏膜炎18.75%、呕吐或腹泻46.88%、肝损害15.63%、出血6.25%,无预处理相关脏器衰竭和死亡事件。移植后3个月评估总缓解率由移植前的56.25%提升至84.38%(P=0.027)。中位随访时间38.5(范围:10~83)个月,8例复发,4例死亡,3年复发率为21.87%,32例患者1年总生存(overall survival,OS)率和无进展生存(progressionfree survival,PFS)率分别为93.8%、86.9%,3年OS率和PFS率分别为86.5%、75.6%,5年OS率和PFS率分别为78.6%、68.0%。结论F/C+AIECy预处理方案的Auto-HSCT一线巩固治疗年轻高危险度分层侵袭性B细胞NHL安全有效,对提高缓解率、降低移植后复发及改善生存有益。Background Autologous hematopoietic stem cell transplantation(Auto-HSCT)is still a consolidation treatment choice for young patients with high-risk,high-intermediate-risk aggressive B-cell non-Hodgkin’s lymphoma(B-NHL)as frontline therapy.With the current pre-treatment plan,more than 30%of patients still experience recurrence after transplantation,so continuous improvement is still needed for the pre-treatment plan.Objective To investigate the safety and effectiveness of Auto-HSCT using tumor-ablative conditioning regimen F/C+AIECy(Fludarabine/Cladribine+Idarubicin+Cytarabine+Etoposide+Cytoxan)for patients with aggressive B cell non-Hodgkin's lymphoma(B-NHL).Methods Clinical data about 32 patients with highrisk,high-intermediate-risk aggressive B-NHL received above-mentioned therapeutic regimen from January 2015 to January 2020 were analyzed retrospectively,and conditioning-related toxicity,engraftment,survival and relapse rate were evaluated.Results A total of 32 patients were included,including 20 males and 12 females,with a median age of 42(range:15-60)years.The medians of collected mononuclear cells and CD34+cells were 11.55(range:8.05-14.76)×10^(8)/kg and 4.56(range:1.58-15.24)×10^(6)/kg,respectively.All patients had successfully completed hematopoietic reconstruction with the implantation rate of 100%,and the median of neutrophil and platelet reconstitution time was 10(range:7-20)days and 14(range:12-30)days in these cases.The incidence of infection during transplantation was 68.75%,and during transplantation the incidence rates of adverse reaction in grade 2 or higher were as follows:mucositis accounting for 18.75%,nausea and vomiting for 46.88%,liver injury for 15.63%,bleeding for 6.25%.No conditioning-related organs'failure and mortality events were found.The complete remission(CR)rate of all patients was significantly higher at 3 months after transplantation compared with before transplantation(56.25%vs 84.38%,P=0.027).The median follow-up time was 38.5(range:10-83)months,during which disease progre

关 键 词：预处理方案 自体造血干细胞移植 B细胞非霍奇金淋巴瘤 生存分析 复发率 

分 类 号：R7[医药卫生—临床医学]