Effect of auto-HSCT using conditioning regimen F/C+AIECy for aggressive B cell NHL
Background Autologous hematopoietic stem cell transplantation(Auto-HSCT)is still a consolidation treatment choice for young patients with high-risk,high-intermediate-risk aggressive B-cell non-Hodgkin's lymphoma(B-NHL)as frontline therapy.With the current pre-treatment plan,more than 30%of patients still experience recurrence after transplantation,so continuous improvement is still needed for the pre-treatment plan.Objective To investigate the safety and effectiveness of Auto-HSCT using tumor-ablative conditioning regimen F/C+AIECy(Fludarabine/Cladribine+Idarubicin+Cytarabine+Etoposide+Cytoxan)for patients with aggressive B cell non-Hodgkin's lymphoma(B-NHL).Methods Clinical data about 32 patients with high-risk,high-intermediate-risk aggressive B-NHL received above-mentioned therapeutic regimen from January 2015 to January 2020 were analyzed retrospectively,and conditioning-related toxicity,engraftment,survival and relapse rate were evaluated.Results A total of 32 patients were included,including 20 males and 12 females,with a median age of 42(range:15-60)years.The medians of collected mononuclear cells and CD34+cells were 11.55(range:8.05-14.76)×108/kg and 4.56(range:1.58-15.24)×106/kg,respectively.All patients had successfully completed hematopoietic reconstruction with the implantation rate of 100%,and the median of neutrophil and platelet reconstitution time was 10(range:7-20)days and 14(range:12-30)days in these cases.The incidence of infection during transplantation was 68.75%,and during transplantation the incidence rates of adverse reaction in grade 2 or higher were as follows:mucositis accounting for 18.75%,nausea and vomiting for 46.88%,liver injury for 15.63%,bleeding for 6.25%.No conditioning-related organs'failure and mortality events were found.The complete remission(CR)rate of all patients was significantly higher at 3 months after transplantation compared with before transplantation(56.25%vs 84.38%,P=0.027).The median follow-up time was 38.5(range:10-83)months,during which disease progression occurred in 8 cases,death occurred in 4 cases,and the 3-year relapse rate of all patients was 21.87%.The 1-year overall survival(OS)rate and progression-free survival(PFS)rate was 93.8%and 86.9%,the 3-year OS rate and PFS rate was 86.5%and 75.6%,the 5-year OS rate and PFS rate was 78.6%and 68%.Conclusion Auto-HSCT using conditioning regimen F/C+AIECy is safe and effective for young patients with high-risk,high-intermediate-risk aggressive B-NHL,and it possess a certain effect for increasing CR rate after transplantation.
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