克拉屈滨联合司莫斯汀、环磷酰胺、阿糖胞苷、依托泊苷(C+SCAV)预处理方案在B细胞淋巴瘤自体造血干细胞移植中的临床应用  

Clinical Application of Cladribine,Smustine,Cyclophosphamide,Cytarabine and Etoposide(C+SCAV)Conditioning Regimen in Autologous Hematopoietic Stem Cell Transplantation for B-Cell Lymphoma

作　　者：李嘉琦 张莹[1] 耿洪智 杨琴 曾良玉 陆雨桐 李彩霞[1] 冯尚龙 LI Jia-qi;ZHANG Ying;GENG Hong-zhi;YANG Qin;ZENG Liang-yu;LU Yu-tong;LI Cai-xia;FENG Shang-long(First Affiliated Hospital of Soochow University,Jiangsu Institute of Hematology,National Clinical Research Center for Hematologic Diseases,Institute of Blood and Marrow Transplantation,Soochow University,Suzhou,Jiangsu,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,江苏苏州215006

出　　处：《中国血液流变学杂志》2024年第4期532-537,共6页Chinese Journal of Hemorheology

基　　金：江苏省血液病医学创新中心(CXZX202201)。

摘　　要：目的评价C+SCAV(克拉屈滨+司莫司汀+环磷酰胺+阿糖胞苷+依托泊苷)预处理方案在侵袭性B细胞非霍奇金淋巴瘤(B-NHL)患者自体造血干细胞移植(auto-HSCT)中的临床疗效与安全性。方法回顾性分析2018年12月—2023年6月在苏州大学附属第一医院血液科采用C+SCAV方案作为auto-HSCT预处理的22例侵袭性B-NHL患者的临床资料,观察疾病转归、治疗相关不良反应及造血重建情况,分析该预处理方案的有效性与安全性。结果截至2024年8月,中位随访时间22.1个月,所有患者的2年无进展生存(PFS)率为67.4%,2年总生存(OS)率为80.6%,2年非复发死亡(NRM)率为5.0%。非复发/难治性疾病的11例患者2年PFS率和OS率分别为90.9%和100%;在复发/难治性疾病接受挽救性治疗的11例患者中,2年PFS率和OS率分别为41.6%和60.6%。共有6例患者移植后复发,4例患者死亡。22例患者均顺利实现造血重建,中性粒细胞植入的中位时间为10(9-20)d,血小板植入的中位时间为12(7-22)d,均未见远期血液系统不良反应发生。非血液系统不良反应主要包括恶心呕吐,腹泻,黏膜炎,感染,粒细胞缺乏伴发热等,其中发生3-4级感染的患者有4例(18.2%),所有不良反应均在治疗后好转,未出现因预处理相关不良反应而终止治疗或死亡的病例。结论C+SCAV预处理方案在侵袭性B-NHL的auto-HSCT中疗效可靠,耐受性良好,且不影响造血重建,具有较好的有效性和安全性。Objective To evaluate the clinical efficacy and safety of the C+SCAV(Cladribine,Smustine,Cyclophosphamide,Cytarabine,and Etoposide)conditioning regimen in autologous hematopoietic stem cell transplantation(auto-HSCT)for patients with aggressive B-cell non-Hodgkin lymphoma(B-NHL).Methods A retrospective analysis was conducted on the clinical data of 22 patients with aggressive B-NHL who underwent auto-HSCT utilizing the C+SCAV conditioning regimen in the Department of Hematology,First Affiliated Hospital of Soochow University from December 2018 to June 2023.The disease outcomes,treatment-related adverse events,and hematopoietic engraftment were observed,and the efficacy and safety of the C+SCAV conditioning regimen were analyzed.Results As of August 2024,the median follow-up time was 22.1 months.The 2-year progression-free survival(PFS)rate for all patients was 67.4%,and the 2-year overall survival(OS)rate was 80.6%,with a 2-year non-relapse mortality(NRM)rate of 5.0%.Among the 11 patients with non-relapsed/refractory disease,the 2-year PFS and OS rates were 90.9%and 100%,respectively.In the subgroup of 11 patients with relapsed/refractory disease receiving salvage therapy,the 2-year PFS and OS rates were 41.6%and 60.6%,respectively.6 patients experienced relapse following transplantation,and 4 patients died.All 22 patients achieved successful hematopoietic engraftment,with a median time to neutrophil engraftment of 10 days(range,9-20 days)and a median time to platelet engraftment of 12 days(range,7-22 days).No long-term hematologic adverse events were observed.The non-hematologic adverse effects primarily included nausea,vomiting,diarrhea,mucositis,infections,and febrile neutropenia.Notably,4 patients(18.2%)experienced grade 3-4 infections.Importantly,all adverse effects were ameliorated following treatment,and there was no case of treatment termination or mortality attributable to conditioning regimen-related adverse effects.Conclusion C+SCAV conditioning regimen demonstrates reliable efficacy and favorable tole

关 键 词：自体造血干细胞移植 预处理 B细胞淋巴瘤 

分 类 号：R733.4[医药卫生—肿瘤]