Eren GÜNDÜZ, Hava Uskudar TEKE, CENGİZ BAL, Tuba BULDUK

Lenfomada Otolog Ko k Hü cre Nakli Hazırlama Rejimi Olarak Beam ve Bücye Protokollerinin Karşılaştırılması

Otolog kök hücre nakli, immünokemoterapi sonrası relaps Hodgkin ve non-Hodgkin lenfomada uzun süreli sağkalımı arttıran standart bir tedavi şeklidir. Başarıyı etkileyen en önemli faktör hastalığın kemosensitif ya da kemorezistan olmasıdır. Ancak transplant ilişkili morbidite/mortalite işlem başarısını halen önemli ölçüde etkilemektedir. Transplant ilişkili morbidite/mortalite açısından minimal kalıntı hastalığın yok edilmesi ile toksisite arasında bir denge sağlanması önemlidir. Bu amaçla yüksek doz rejimlerin terapötik penceresini arttırmaya yönelik çabalar devam etmektedir. Bununla birlikte bir yüksek doz tedavinin diğerine üstünlüğünden bahsetmek için kesin kanıtlar mevcut değildir. Farklı rejim arayışları devam etmekle birlikte özellikle karmustin temininde bir dönem yaşanan sıkıntı rejim değişikliğini zorunlu kılmıştır. Bu süreçte merkezimizde BEAM yerine BuCyE protokolü tercih edilmiştir. Çalışmamızda BuCyE’nin BEAM’a kalıcı bir alternatif olma potansiyelinin değerlendirilmesi amaçlanmıştır. Çalışmaya otolog nakil işlemleri 2006-2017 yılları arasında gerçekleştirilen 20 hasta dahil edildi.Hastalar 2 gruba ayrılarak demografik, klinik ve laboratuvar özellikleri açısından değerlendirildi. BuCyE uygulanan hasta sayısı 10 idi. Karşılaştırma amacıyla kullanılan BEAM grubuna seçilen hastalar verilerine ulaşılması mümkün olan hastalara ait isim listesinden rastgele seçildi. Sağkalım süresi; kaybedilen hastalar için nakil günü ile ölüm tarihi arası, yaşayan hastalar için nakil günü ile değerlendirme tarihi arası olarak hesaplandı. Çalışmamızda birçok parametre için veriler 2 grupta da benzer olmakla birlikte sağkalım BEAM lehine bulundu (55.25±15.29 vs 12.12±4.02 ay, p=0.02). Hasta sayısı ve takip süresi kesin sonuçlar çıkarmak için yetersiz olmakla birlikte verilerimiz sağkalım süresi ve merkezimizin mevcut tecrübesi itibariyle BEAM protokolünün lenfoma için BuCyE’ye tercih edilecek hazırlama rejimi olduğunu düşündürmüştür. Ancak prospektif karşılaştırmalı çalışmaların yokluğunda bir hazırlama rejimini tavsiye etmek mevcut kanıt düzeyleri düşük olduğundan güçtür. Devam eden klinik çalışmalara katılım önemlidir.

Comparison of Beam and Bücye Protocols as a Conditioning Regimen for Aütologoüs Stem Cell Transplantation in Lymphoma

Autologous stem cell transplantation is a type of standard therapy which increases the long term survival in post immunochemotherapy relapsed Hodgkin and non-Hodgkin lymphoma. Success is most commonly affected by the presence of chemosensitive or chemoresistant disease. However, transplant related morbidity/mortality still affects the success of the procedure. In the era of transplant related morbidity/mortality it is important to provide a balance between minimal residual disease and toxicity. To manage this goal trials on increasing the therapeutic window of high dose regimens are continuing. Unfortunately, we do not have conclusive evidence to say that one high dose regimen is better than the other. Different regimen trials are still going on but lack of carmustine for a while led to a compulsory change in regimen preference. During this period BuCyE was preferred instead of BEAM in our center. In this study, our aim was to decide whether BuCyE can be a permanent alternative to BEAM. Twenty patients who underwent autologous transplantation between 2006-2017 were included in the study. Patients were divided into 2 groups demographic, clinical and laboratory characteristics were evaluated. The number of patients in BuCyE group was 10. BEAM group which is used for comparison was chosen randomly from the list of patients with accessible data. Survival was calculated as the time between day of transplantation and data collection or exitus. Many of the parameters were similar between 2 groups in our study but survival was longer in favor of BEAM group (55.25±15.29 vs 12.12±4.02 months, p=0.02). Despite number of patients and follow up period is not enough to make definitive conclusions our data suggested that BEAM was superior to BuCyE in lymphoma in terms of survival and center experience. In the absence of prospective trials it is difficult to suggest a conditioning regimen due to low level of evidence. It is important to participate in ongoing clinical trials.

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