BEAM方案预处理行自体外周血干细胞移植治疗恶性淋巴瘤

The treatment of BEAM conditioning regimens for patients with malignant lymphoma undergoing autologous peripheral blood stem-cell transplantation

背景与目的:自体外周血干细胞移植(autologous peripheral blood stem-cell transplantation, APBSCT)是目前治疗恶性淋巴瘤(ML)的主要方法之一,预处理是APBSCT的重要环节,选择高效低毒的预处理方案能有效提高ML治愈率。本研究探讨BEAM方案预处理行APBSCT治疗ML的方法和疗效。方法:对22例ML患者进行APBSCT,17例患者采用经典的BEAM方案:卡莫司汀300mg/m2·d-1×1d(—6d),依托泊苷200mg/m2·d-1×4d(-5d～-2d),阿糖胞苷400mg/m2·d-1×4d(-5d～-2d),马法兰140mg/m2·d-1×1d(-1d)。5例患者在经典BEAM方案基础上加用去甲氧柔红霉素20～40mg,以增强预处理疗效。结果:除1例患者在回输外周血干细胞后的第7天死于多器官功能衰竭以外,其余患者移植后均获得造血功能重建,移植后外周血中性粒细胞绝对计数(ANC)≥0.5×109/L及血小板≥20×109/L的时间分别为(11.4±4.4)d和(15.6±3.8)d。中位随访时间433(7～1410)d,13例患者无病生存,2年预计总生存率为(68.2±3.3)%,2年预计无病生存率(DFS)为(59.1±3.2)%。移植前完全缓解组与移植前未完全缓解组(含部分缓解、复发、进展状态)患者之间的2年总生存率分别为(91.6±3.1)%和(40.2±4.2)%,DFS分别为(91.1±4.2)%和(20.2±4.6)%,两者均有显著性意义(P<0.001)。结论:BEAM方案为主的APBSCT治疗ML患者安全、高效,能提高患者的无病生存期,移植前尽量使患者达完全缓解,能够提高移植的成功率。

Background and purpose： Autologous peripheral blood stem-cell transplantation （APBSCT） is a main treatment for patients with malignant lymphoma （ML）. The conditioning regimen is considerable, but safe and effective conditioning regimens are necessary for APBSCT. We retrospectively evaluated the treatment and effect of BEAM conditioning regimens for patients with ml undergoing APBSCT. Methods： 22 patients with ml received APBSCT. 17 patients received conditioning regimens of BEAM：BCNU 300 mg/m2 · d^-1× 1 d（-6 d）,VP16 200 mg/m^2 · d^1×4 d（-5 d to -2 d）, cytarabine 400 mg/m^2 · d^-1×4 d（-5 d to -2 d）, melphalan 140 mg/m^2 · d^-1×1 d（-1 d）. 5 patients received conditioning regimens of BEAM combined with idarubicin （20-40 mg） to strengthen effectiveness. Results： Except for 1 case who died in multiple organ failure before re-establishment ofhaematogenesis, all patients were successfully engrafted. The time of ANC ≥ 0.5 × 10^9/L and PLT ≥20× 10^9/L were at（ 11.4±4.4） and（15.6±3.8）d, respectively. With a median follow-up of 433 days （range, 7-1 410） 13 patients with complete remission are alive. The estimated 2-year overall survival （OS） and disease free survival （DFS） were （68.2±3.3）% and （59.1±3.2）%, respectively. The OS of the patients with complete remission and incomplete remission （partial remission, relapse, progression of disease） pretransplant were （91.6±3.1）% and（40.2±4.2）%, and DFS were（91.1±4.2）% and（20.2±4.6）% ,respectively（P〈0.001）. Conclusions： The treatment of BEAM conditioning regimens for patients with ml undergoing APBSCT is safe and effective. The success ratio of APBSCT depends on the status of complete remission pretransplant.