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

OBJECTIVE: To investigate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of patients with Ⅲ,Ⅳ non-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 with Ⅲ, 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%, grade Ⅲ–Ⅳ occurred 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 some Ⅲ,Ⅳ NHL 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.