背景:在allo-HSCT中充分研究了氟达拉滨,然后进行分级全身照射(Flu/FTBI)作为调节。环磷酰胺作为FTBI前(Cy/FTBI)和FTBI后(FTBI/Cy)也显示出可接受的结果,虽然数据有限。然而,与FTBI/Cy不同,没有研究检查FTBI,然后是氟达拉滨(FTBI/Flu)。由于物流,我们已经使用了FTBI/Flu或FTBI/Cy,并有适当的干细胞输注时间。
目的:使用FTBI/Flu和FTBI/Cy条件报告结果。
方法:回顾性图表回顾。
方法:单一机构:学术医院/县医院。
方法:患者(18-99岁,M/F)诊断为恶性血液病1/2015-2/2021,在我们机构接受allo-HSCT。
方法:主要:自移植以来的OS和EFS,在FTBI/流感和FTBI/Cy之间进行分层。次要:患者/治疗特征,GVHD,和(非)复发相关死亡率((N)RM)。P≤0.05被认为是显著的。
结果:在26例患者中,中位年龄为47.5岁,65%的男性,65%的西班牙裔,所有的50%,和42.3%与AML。移植前,65.4%的患者处于CR1,23.1%的患者处于CR2/3。疾病风险指数(DRI)为73.1%的中间和23.1%的高。MSD被施用到26.9%,MUD至38.5%,和单倍体干细胞达到34.6%。FTBI/流感调理给药为84.6%,FTBI/Cy给药为15.4%。移植后GVHD的预防是环磷酰胺/他克莫司/霉酚酸酯的80.8%和他克莫司/甲氨蝶呤的19.2%。自从移植以来,在总人口中,3年(3y)OS为81%(15.4%有NRM),3y-EFS为72.5%(7.7%有复发)。FTBI/Flu2y-OS为77.5%,FTBI/Cy2y-OS为100%(p=0.38)。FTBI/Flu2y-EFS为77.5%,FTBI/Cy2y-EFS为50%(p=0.24)。任何级别/任何类型的急性GVHD发生在77.3%的FTBI/流感患者与50%的FTBI/Cy患者(p=0.29),15.4%的FTBI/Flu患者经历G3急性肠道GVHD,而0%的FTBI/Cy患者(p=0.99)。任何级别/任何类型的慢性GVHD发生在27.3%的FTBI/流感患者与50%的FTBI/Cy患者(p=0.56);然而,50%的FTBI/流感患者经历G3慢性肠道GVHD与0%的FTBI/Cy患者(p=0.99)。
结论:鉴于我们的大多数患者患有中度/高度DRI,使用两种翻转调节方案的OS和EFS通常相似且明显.然而,更多任何类型/等级,在FTBI/流感人群中发现了急性GVHD和G3急性/慢性肠道GVHD病例,虽然不重要。
BACKGROUND: Fludarabine followed by fractionated total body irradiation (Flu/FTBI) as conditioning was well-studied in allo-HSCT. Cyclophosphamide as pre-FTBI (Cy/FTBI) and post-FTBI (FTBI/Cy) has also shown acceptable outcomes, although data are limited. However, unlike FTBI/Cy, no studies have examined FTBI followed by fludarabine (FTBI/Flu). Due to logistics, we have used FTBI/Flu or FTBI/Cy with appropriate stem cell infusion timing.
OBJECTIVE: Report outcomes using FTBI/Flu and FTBI/Cy conditioning.
METHODS: Retrospective chart review.
METHODS: Single institution: academic hospital/county hospital.
METHODS: Patients (18-99 years, M/F) with hematologic malignancies diagnosed 1/2015-2/2021 who underwent allo-HSCT at our institution.
METHODS: Primary: OS and EFS since time of transplant, stratified between FTBI/Flu and FTBI/Cy. Secondary: Patient/treatment characteristics, GVHD, and (non-) relapse-related mortality ((N)RM) rates. P≤0.05 was considered significant.
RESULTS: In 26 patients, median age was 47.5 years, 65% males, 65% Hispanic, 50% with ALL, and 42.3% with AML. Pre-transplant, 65.4% of patients were at CR1, and 23.1% were at CR2/3. Disease risk index (DRI) was intermediate for 73.1% and high for 23.1%. MSD was administered to 26.9%, MUD to 38.5%, and haploidentical stem cells to 34.6%. FTBI/flu conditioning was administered to 84.6% and FTBI/Cy to 15.4%. Post-transplant GVHD prophylaxis was cytoxan/tacrolimus/mycophenolate in 80.8% and tacrolimus/methotrexate in 19.2%. Since transplant, in the overall population, 3-year (3y) OS was 81% (15.4% had NRM) and 3y-EFS was 72.5% (7.7% had relapse). FTBI/Flu 2y-OS was 77.5% and FTBI/Cy 2y-OS was 100% (p=0.38). FTBI/Flu 2y-EFS was 77.5% and FTBI/Cy 2y-EFS was 50% (p=0.24). Any grade/any type acute GVHD occurred in 77.3% of FTBI/Flu patients vs. 50% of FTBI/Cy patients (p=0.29), with 15.4% of FTBI/Flu patients experiencing G3 acute gut GVHD vs 0% of FTBI/Cy patients (p=0.99). Any grade/any type of chronic GVHD occurred in 27.3% of FTBI/Flu patients vs. 50% of FTBI/Cy patients (p=0.56); however, 50% of FTBI/Flu patients experienced G3 chronic gut GVHD vs. 0% of FTBI/Cy patients(p=0.99).
CONCLUSIONS: Given most of our patients had intermediate/high DRI, the OS and EFS using both flipped conditioning regimens were generally similar and appreciable. However, more any type/grade, acute GVHD and G3 acute/chronic gut GVHD cases were identified in the FTBI/Flu population, although not significant.