高危或难治弥漫大B细胞淋巴瘤自体造血干细胞移植采用西达本胺联合BEAC方案预处理的临床疗效

Clinical efficacy of chidamide combined with BEAC preconditioning regimen in high-risk or refractory diffuse large B-cell lymphoma receiving autologous hematopoietic stem cell transplantation

目的探讨自体造血细胞移植治疗高危或难治弥漫大B细胞淋巴瘤(DLBCL)采用西达本胺联合BEAC(卡莫司汀+依托泊苷+阿糖胞苷+环磷酰胺)预处理方案的临床疗效。方法回顾性分析2022年3月至2023年5月徐州市中心医院收治的10例西达本胺联合BEAC方案预处理后行自体造血干细胞移植的高危或难治DLBCL患者的临床资料。总结预处理过程及造血重建过程相关不良反应、移植后造血干细胞重建时间、近期疗效等。结果 10例患者中, 女性6例, 男性4例;中位年龄58岁(27~68岁);10例患者移植后均获得造血重建。中性粒细胞植入中位时间为移植后11 d(7~12 d), 血小板中位植入时间为移植后12 d(9~16 d)。血液学不良反应:2例出现3级发热性中性粒细胞减少, 1例出现4级发热性中性粒细胞减少;3例出现2级贫血, 1例出现3级贫血;非血液学不良反应:1例出现2级恶心、呕吐, 1例腹泻。移植后随访>3个月8例, 其中6例获得完全缓解, 1例获得部分缓解, 1例患者(存在TP53缺失)移植1个月后出现疾病进展。结论自体造血干细胞移植治疗高危或难治DLBCL患者采用西达本胺联合BEAC方案预处理疗效较好, 不良反应可耐受。

Objective To investigate the clinical efficacy of chidamide combined with BEAC(camustine+etoposide+cytarabine+cyclophosphamide)preconditioning regimen in high-risk or refractory diffuse large B-cell lymphoma(DLBCL)receiving autologous stem cell transplantation.Methods The clinical data of 10 high-risk or refractory DLBCL patients with autologous stem cell transplantation after receiving chidamide combined with BEAC preconditioning regimen who were admitted to Xuzhou Central Hospital from March 2022 to May 2023 were retrospectively analyzed.The related complications during preconditioning and hematopoietic reconstruction process,the time of hematopoietic stem cell reconstruction after transplantation,and the short-term efficacy were summarized.Results Of the 10 patients,6 were women and 4 were men;the median age was 58 years old(27-68 years old).Hematopoietic reconstruction was achieved in all 10 patients after transplantation.The median time of neutrophil engraftment was 11 d(range 7-12 d),and the median time of platelet engraftment was 12 d(range 9-16 d)after transplantation.Hematological adverse reactions were described as follows:2 cases had grade 3 febrile neutropenia,1 case had grade 4 febrile neutropenia,3 cases had grade 2 anemia,and 1 case had grade 3 anemia.Non-hematological adverse reactions were described as follows:1 case had grade 2 nausea with vomiting,and 1 case had diarrhea.Eight patients were followed-up for>3 months after transplantation,6 patients achieved complete remission,1 patient achieved partial remission,and 1 patient with TP53 deletion developed disease progression 1 month after transplantation.Conclusions Autologous hematopoietic stem cell transplantation with chidamide combined with BEAC preconditioning regimen is effective for patients with high-risk or refractory DLBCL,and the adverse reactions are tolerable.