[Advances in leukemia inhibitors targeting PI3K/AKT/mTOR pathway].

Abstract

Objective To investigate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT)in the treatment of patients with Ⅲ,Ⅳ non-Hodgkin lymphoma (NHL), and compared the efficacy between Cy-fractionated to talbody irradiation (fTBI)based conditioning regimen and Maryland, horse flange and mitoxantrone (BMM). Methods The clinical data of 47 patients with Ⅲ, Ⅳ NHL after allo-HSCT from November 1998 to May 2014 were collected and retrospectively analyzed. To observe the hematopoietic reconstruction recovery after transplantation, cumulative incidence of acute graft-versus-host-disease (aGVHD)and chronic graft-versus-host-disease (cGVHD), transplantation related mortality (TRM), recurrence rate (RR), disease-free survival (DFS), overall survival (OS). Compare the efficacy of fTBI and BMM conditioning regimen at the same time. Results Neutrophils achieving 0.5 × 109/L and platelets achieving 50 × 109/L on day 17 (range, 10-72)post transplantation. Acute GVHD occurred in 53.19%, among them, grade Ⅰ-Ⅱ occurred in 42.55%, grade Ⅲ-Ⅳ occurred in 10.65%, and cGVHD occurred in 21.28%. 21 patients were alive with a median follow up of 9.7 months (0.2-149.1 months). Overall survival (OS)was 73.5%, 49.3%, 40.1% respectively in the first, third and fifth year in Cy-fTBI group; in BMM group it was 67.8%, 32.9% and 31.4% respectively, and disease-free survival (DFS)was 65.3%, 45.6%, 30.2% respectively in the first, third and fifth year. In Cy-fTBI group, the recurrence rate (RR)and transplantation related mortality (TRM)in the first year were 18.9%, 23.0% respectively, the third year were 19.5%, 38.3% and the fifth year were 35.2%, 39.2%. In BMM group, RR and TRM in the first year were 27.4%, 24.5% respectively, the third year were 38.9%, 46.4% and the fifth year were 39.2%, 48.2%. However, there was no significant difference in the indicator of OS, DFS, RR, TRM in the two groups. Conclusion Allo-HSCT could make some Ⅲ,Ⅳ NHL patients achieve long-term disease-free survival, but the TRM was still high relatively. Moreover, compared with the program of BMM conditioning regimen, Cy-fTBI might reduce the TRM and RR, meanwhile, increase the DFS and OS. However, due to the small number cases of two groups, there was no statistical significant difference. Key words: Lymphoma, non-Hodgkin; Recurrence; Refractory; Hematopoietic stem cell transplantation; Transplantation conditioning