南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (12): 1760-1767.doi: 10.12122/j.issn.1673-4254.2020.12.10

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IEAC或CEAC预处理方案用于淋巴瘤自体造血干细胞移植的疗效与安全性比较

熊艺颖，陈建斌，刘 林，罗小华，唐晓琼，王 欣，肖 青，张红宾，王 利
  

  • 出版日期:2020-12-20 发布日期:2020-12-28

IEAC versus CEAC high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation for lymphoma: analysis of efficacy and safety in 106 cases

  • Online:2020-12-20 Published:2020-12-28

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摘要： 目的 评价IEAC或CEAC方案预处理在自体造血干细胞移植（ASCT）治疗淋巴瘤的疗效与安全性。方法 回顾性分析了2013年~2018年在我院以IEAC方案（去甲氧柔红霉素+依托泊苷+阿糖胞苷+环磷酰胺）和CEAC方案（洛莫司汀+依托泊苷+阿糖胞苷+环磷酰胺）预处理后行ASCT的106例淋巴瘤患者资料，其中IEAC组43例，CEAC组63例患者，两组患者的临床特征无显著差异。通过对两组的造血重建时间、不良反应以及生存情况进行比较分析来评价预处理方案的疗效与安全性。此外，对可能影响生存的因素进行了单因素以及多因素的分析。结果 104例患者移植后造血重建，2例患者出现治疗相关死亡，两组的造血重建时间无显著差异。移植后中位随访27.4月（4.3~74.3月），患者的5年无进展生存率和总生存率分别为72.9%和81.9%，主要的2级以上的不良反应为感染、口腔黏膜炎、恶心呕吐、肝功能损害、心脏毒性、低钾血症以及腹泻，两组的生存和不良反应无显著差异。T细胞淋巴瘤和移植前未获得完全缓解是无进展生存率（P值分别为0.015和0.007）和总生存率（P值分别为0.038和0.031）的危险因素，移植后3个月能获得完全缓解的患者可以获得更好的进展生存率（P=0.007）和总生存率（P=0.003）。结论 IEAC或CEAC预处理联合ASCT治疗淋巴瘤是安全有效的，可作为淋巴瘤ASCT预处理的备选方案。

关键词: 自体造血干细胞移植；淋巴瘤；IEAC；CEAC

Abstract: Objective To evaluate the efficacy and safety of IEAC (idarubici, etoposide, cytosine arabinoside, and cyclophosphamide) and CEAC (lomustine, etoposide, cytosine arabinoside, and cyclophosphamide) high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) in the treatment of lymphoma. Method We retrospectively analyzed the data of 106 lymphoma patients undergoing ASCT from 2013 to 2018 using IEAC (n=43) or CEAC (n=63) regimens. The time of hematopoietic reconstruction, adverse events and the patients' survival outcomes in the two groups were compared to evaluate the efficacy and safety of the two regimens. Univariate and multivariate analyses were performed to identify the factors potentially affecting the patients' survival. Results In the total of 106 patients, successful hematopoietic reconstruction was achieved in 104 patients and treatment-related deaths occurred in 2 patients. No significant differences were observed in the time to hematopoietic recovery, adverse events or survival outcomes between the patients receiving IEAC and CEAC regimens. In the 104 patients with successful hematopoietic reconstruction who were followed for a median of 27.4 months (range 4.3 to 74.3 months), the 5-year progress-free survival (PFS) and overall survival (OS) rates were 72.9% and 81.9% , respectively. The main adverse events (beyond grade 2 based on CTCAE v5.0) included infection, oral mucositis, nausea and vomiting, liver damage, cardiotoxicity, hypokalemia, and diarrhea. No significant difference was found in the survival outcomes or adverse events between the 2 regimens. T cell lymphoma and failure to achieve complete remission (CR) before ASCT were the risk factors of PFS (P=0.015 and P=0.007, respectively) and OS (P=0.038 and 0.031, respectively). The patients who achieved CR 3 months after the transplantation had higher rates of PFS (P=0.007) and OS (P=0.003). Conclusion IEAC and CEAC regimens prior to by ASCT are both safe and effective in the treatment of lymphoma and can be used as alternative conditioning regimens for lymphoma patients undergoing ASCT.

Key words: autologous hematopoietic stem cell transplantation; lymphoma; IEAC regimen; CEAC regimen