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.