The Safety And Short-term Efficacy Of The Treatment Of Fludarabing Combined BEAM Conditioning Regiment For Patients With Non-Hodgkin's Lymphoma Undergoing Autologouse Peripheral Blood Stem Cell Transplantation

【Background and Objective】Autologous peripheral blood stem cell transplantation (APBSCT) is one of the main treatments for patients with non-Hodgkin's lymphoma (NHL). The conditioning regimen is the important part of APBSCT. Effective and safe conditioning regimens can improve the cure rate of NHL. Fludarabine (FDB) on the cell cycle of lymphocytes and quiescent (G0) lymphocytes are cytotoxic, with a wide range of anti-tumor activity. We evaluated the the safety and short-term efficacy of fludarabine combined BEAM conditioning regimens for patients with NHL undergoing APBSCT.【Method】Nineteen patients with NHL received APBSCT. High-dose cyclophosphamide therapy followed by G-CSF was used for PBSC mobilization. Ten patients received conditioning regimens of BEAM(BEAM group): BCNU 150mg/m²Â·d^-1×1d(-7d),VP16 150mg/m²Â·d^-1×4d(-6d^-3d),Ara-C 200mg/m²Â·d^-1×4 d(-6d^-3d),Mel 60mg/m²Â·d^-1×1d(-2d). Nine patients received conditioning regimens of BEAM combined with Fludarabine(FBEAM group): 50mg/d^-1×3d(-7d^-5d). The PBSC was infused after 48 hours of HDC. The median follow-up period in FBEAM group was 11(2～25) months, and the median follow-up period in BEAM group was 24(9～40) months.【Results】All patients were successfully engrafted after infusing PBSC. The average lowest leukocyte of FBEAM group was less than that of BEAM group[(0.27±0.39)×10⁹/L VS (0.46±0.33)×10⁹/L),P=0.030]. The average time to ANC <0.5×10⁹/L of FBEAM group was shorter than that of BEAM group(2.9d±1.5d VS 5.4d±2.4d,P=0.015). On the other hand, the average time to ANC≥0.5×10⁹/L of FBEAM group was also shorter than that of BEAM group(10.9d±2.3d VS 13.4d±2.3d,P=0.029).But the average time of neutropenia wasn't significantly different in two groups(7.9d±2.0d VS 8.2d±2.8d,p=0.784). The average time to PLT≥20×10⁹/L of FBEAM group was not different to that of BEAM group(11.4d±6.1d VS 9.8d±2.0d, p=0.433). The average lowest lymphocyte of FBEAM group was Less than that of BEAM group[(0.11±0.22)×10⁹/L VS(0.19±0.15)×10⁹/L), P<0.050]. The peripheral blood lymphocyte subsets analysis in FBEAM group showed that the total number and percentage of CD4+T lymphocytes decreased, but he total number and percentage of NK cells increased after APBCST. The differences were statistically significant. The adverse reactions of gastrointestinal tract and oral mucosa were close in tow groups.VOD,hemorrhagic cystitis,pretreatment-related interstitial pneumonia,Liver and kidney dysfunction were not happened in tow groups. The rate of infectious fever was close in two groups (5/9 VS 4/10).But the average time of fever in FBEAM group was longer than that in BEAM group(6.0d±3.1d VS 2.3d±1.0d, P=0.041).One patient suffered hemolytic in FDB group, another patient suffered idiopathic thrombocytopenic purpura (ITP).One patient died three months late because of disease progression in FBEAM groups. One patient died nine months late because of disease progression in BEAM groups. The estimated one-year and two-years disease free survival(DFS) of FBEAM group were the same(64.8%).And the estimated one-year and two-years DFS of BEAM group were 70% and 60%. The two-years DFS of FBEAM group was higher than that of BEAM group(64.8% VS 60%),but it had no significant difference(P=0.971).【Conclusion】The treatment of fludarabine combined BEAM conditioning regimen for patients with non-Hodgkin's lymphoma undergoing APBSCT is safe. The time of hematopoietic reconstruction is short, and the adverse effects is tolerable for patients with non-Hodgkin's lymphoma. The current short-term outcome is good, but the long-term effect need a longer time to follow-up.