CY-fTBI与BMM预处理方案行异基因造血干细胞移植治疗Ⅲ、Ⅳ期非霍奇金淋巴瘤：15年单中心疗效分析

Therapeutic effect of CY-fTBI and BMM conditioning regimen in the process of allo-HSCT treatingⅢ,Ⅳnon-Hodgkin lymphoma：15 years analysis of single-center

目的：比较预处理方案Cy-fTBI（环磷酰胺＋分次全身照射）与BMM（白消安＋马法兰＋米托蒽醌）在异基因造血干细胞移植（allo-HSCT）治疗Ⅲ、Ⅳ期非霍奇金淋巴瘤（NHL）疗效上的差异。方法对1998年11月至2014年5月接受allo-HSCT治疗的47例Ⅲ、Ⅳ期NHL病例进行回顾性分析，观察比较Cy-fTBI和BMM预处理方案两组患者移植后造血重建时间、急性移植物抗宿主病（aGVHD）和慢性移植物抗宿主病（cGVHD）累积发生率、移植相关死亡率（TRM）、复发率（RR）、无病生存率（DFS）和总体生存率（OS）。结果移植后中性粒细胞≥0.5×10^9/L和血小板计数≥50＆#215;109/L的中位时间为17（10～72）d和27（5～98）d；aGVHD发生率为53.19%，Ⅰ～Ⅱ度占42.55%，Ⅲ～Ⅳ度占10.64%；cGVHD发生率为21.28%；中位随访9.7（0.2～149.1）个月，47例患者中21例生存。Cy-fTBI组1、3、5年OS率分别为73.5%、49.3%、40.1%，DFS率分别为71.4%、45.6%、39.3%。BMM组1、3、5年OS率分别为67.8%、32.9%、31.4%，DFS率分别为65.3%、31.1%、30.2%。Cy-fTBI组1、3、5年RR率分别为18.9%、19.5%、35.2%，TRM率分别为23.0%、38.3%、39.2%。BMM组1、3、5年RR分别为27.4%、38.9%、39.2%，TRM率分别为24.5%、46.4%、48.2%，两组在OS、DFS、RR、TRM等指标上差异无统计学意义。结论 Allo-HSCT是治疗Ⅲ、Ⅳ期NHL的有效手段，但TRM仍相对较高。Cy-fTBI预处理方案与BMM方案相比，减少了TRM、RR，增加了DFS和OS，但差异无统计学意义。

Objective To investigate the efficacy of allogeneic hematopoietic stem cell transplantation（allo-HSCT）in the treatment of patients withⅢ,Ⅳnon-Hodgkin lymphoma（NHL）, and compared the efficacy between Cy-fractionated to talbody irradiation（fTBI）based conditioning regimen and Maryland, horse flange and mitoxantrone（BMM）. Methods The clinical data of 47 patients withⅢ, Ⅳ NHL after allo-HSCT from November 1998 to May 2014 were collected and retrospectively analyzed. To observe the hematopoietic reconstruction recovery after transplantation, cumulative incidence of acute graft- versus- host- disease （aGVHD） and chronic graft- versus- host- disease （cGVHD）, transplantation related mortality （TRM）, recurrence rate （RR）, disease-free survival （DFS）, overall survival（OS）. Compare the efficacy of fTBI and BMM conditioning regimen at the same time. Results Neutrophils achieving 0.5× 10^9/L and platelets achieving 50 × 10^9/L on day 17 （range, 10-72） post transplantation. Acute GVHD occurred in 53.19%, among them, grade Ⅰ-Ⅱ occurred in 42.55%, gradeⅢ-Ⅳoccurred in 10.65%, and cGVHD occurred in 21.28%. 21 patients were alive with a median follow up of 9.7 months（0.2-149.1 months）. Overall survival（OS）was 73.5%, 49.3%, 40.1%respectively in the first, third and fifth year in Cy-fTBI group;in BMM group it was 67.8%, 32.9%and 31.4%respectively, and disease-free survival（DFS）was 65.3%, 45.6%, 30.2%respectively in the first, third and fifth year. In Cy-fTBI group, the recurrence rate（RR）and transplantation related mortality（TRM）in the first year were 18.9%, 23.0% respectively, the third year were 19.5%, 38.3% and the fifth year were 35.2%, 39.2%. In BMM group, RR and TRM in the first year were 27.4%, 24.5% respectively, the third year were 38.9%, 46.4%and the fifth year were 39.2%, 48.2%. However, there was no significant difference in the indicator of OS, DFS, RR, TRM in the two groups. Conclusion Allo-HSCT could make someⅢ,ⅣNHL patients achieve long-term disease-free survival, but the TRM was still high relatively. Moreover, compared with the program of BMM conditioning regimen, Cy-fTBI might reduce the TRM and RR, meanwhile, increase the DFS and OS. However, due to the small number cases of two groups, there was no statistical significant difference.