Outcome of medium-dose VP-16/CY/TBI superior to CY/TBI as a conditioning regimen for allogeneic stem cell transplantation in adult patients with acute lymphoblastic leukemia
Outcome of medium-dose VP-16/CY/TBI superior to CY/TBI as a conditioning regimen for allogeneic stem cell transplantation in adult patients with acute lymphoblastic leukemia
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DOI：
10.1007/s12185-011-0944-2
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发表时间：
2011-11
影响因子：
2.1
通讯作者：
A. Shigematsu;J. Tanaka;R. Suzuki;Y. Atsuta;T. Kawase;Y. Ito;T. Yamashita;T. Fukuda;K. Kumano;K. Iwato;F. Yoshiba;H. Kanamori;N. Kobayashi;T. Fukuhara;Y. Morishima;M. Imamura
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作者：
A. Shigematsu;J. Tanaka;R. Suzuki;Y. Atsuta;T. Kawase;Y. Ito;T. Yamashita;T. Fukuda;K. Kumano;K. Iwato;F. Yoshiba;H. Kanamori;N. Kobayashi;T. Fukuhara;Y. Morishima;M. Imamura
急性淋巴细胞白血病（ALL）患者异基因干细胞移植（SCT）前预处理方案的选择很重要。我们回顾性比较了中剂量 VP-16/环磷酰胺/全身照射 (VP/CY/TBI) 方案和 CY/TBI 的结果。比较了满足以下所有标准的 529 名患者（VP/CY/TBI：n= 35，CY/TBI：n= 494）：首次接受 SCT，年龄 15-59 岁； SCT 第一次或第二次完全缓解；骨髓或外周血作为干细胞来源；和HLA表型匹配的供体。患者的中位年龄为 34 岁，接受 VP/CY/TBI 的患者更年轻（28 岁 vs. 34 岁，P=0.02）。接受 CY/TBI 的患者的累积复发率和非复发死亡率 (NRM) 较高（复发 P= 0.01，NRM P< 0.01）。中位随访期为 36.9 个月后，VP/CY/TBI 组的 5 年总生存 (OS) 率为 82.2%，CY/TBI 组为 55.2%。多变量分析显示，VP/CY/TBI 组的 OS 和无病生存 (DFS) 明显更好[DFS 风险比：0.21（95% 置信区间：0.06–0.49），OS 风险比：0.25（95% 置信区间：0.08–0.59）]。 VP/CY/TBI 与较低的复发率相关，并且 NRM 不增加，因此成人 ALL 患者的生存率比 CY/TBI 更好。
The choice of conditioning regimen before allogeneic stem cell transplantation (SCT) in patients with acute lymphoblastic leukemia (ALL) is important. We retrospectively compared outcomes of medium-dose VP-16/cyclophosphamide/total body irradiation (VP/CY/TBI) regimen and CY/TBI. Five hundred and twenty-nine patients (VP/CY/TBI:n= 35, CY/TBI:n= 494) who met all of the following criteria were compared: first time for SCT, aged 15–59 years; first or second complete remission at SCT; bone marrow or peripheral blood as stem cell source; and HLA phenotypically matched donor. Median age of the patients was 34 years, and patients who received VP/CY/TBI were younger (28 vs. 34 years,P= 0.02). Cumulative incidences of relapse and non-relapse mortality (NRM) were higher for patients who received CY/TBI (P= 0.01 for relapse,P< 0.01 for NRM). After a median follow-up period of 36.9 months, 5-year overall survival (OS) rates were 82.2% in the VP/CY/TBI group and 55.2% in the CY/TBI group. OS, and disease-free survival (DFS) in the VP/CY/TBI group were shown to be significantly better by multivariate analysis [hazard ratio: 0.21 (95% confidence interval: 0.06–0.49) for DFS, hazard ratio: 0.25 (95% confidence interval: 0.08–0.59) for OS]. VP/CY/TBI was associated with a lower relapse rate and no increase in NRM, resulting in better survival than that in CY/TBI for adult ALL patients.